Provider Demographics
NPI:1306806088
Name:HENRY, RONALD GLOVER (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GLOVER
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 VISION PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3001
Mailing Address - Country:US
Mailing Address - Phone:281-404-3000
Mailing Address - Fax:936-273-6911
Practice Address - Street 1:135 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3001
Practice Address - Country:US
Practice Address - Phone:281-404-3000
Practice Address - Fax:936-273-6911
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE1870208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121749902Medicaid
TX121749902Medicaid
85T511Medicare ID - Type Unspecified
TX340014669Medicare PIN