Provider Demographics
NPI:1316908999
Name:HENRY, DAVID BYROM (PHYSICIAN'S ASSISTAN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BYROM
Last Name:HENRY
Suffix:
Gender:M
Credentials:PHYSICIAN'S ASSISTAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W. CHARLESTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:760-380-5861
Practice Address - Street 1:1800 W. CHARLESTON BLVD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-383-2000
Practice Address - Fax:760-380-5861
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16742363AM0700X
363AM0700X
NV1346363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty