Basic Information
| Provider Information | |||||||||
| NPI: | 1386640118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2041 GEORGIA AVE NW STE 6101 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028653785 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVENUE NW DEPT OF SURGERY | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200603322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028653785 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | L3777 | TX | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | MD036316 | DC | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 150061301 | 05 | TX | MEDICAID |