Provider Demographics
NPI:1487743258
Name:HENAO, JOSE G (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:HENAO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3536
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-3536
Mailing Address - Country:US
Mailing Address - Phone:956-541-4849
Mailing Address - Fax:956-982-1629
Practice Address - Street 1:5460 PAREDES LINE RD
Practice Address - Street 2:STE 209
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-9741
Practice Address - Country:US
Practice Address - Phone:956-541-4849
Practice Address - Fax:956-982-1629
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1613P213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154530301Medicaid
TX62JNOtherBCBS
TX00259HMedicare ID - Type Unspecified
TX62JNOtherBCBS