Provider Demographics
NPI:1467342881
Name:HENRY, RODERICK DANNTE JR
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:DANNTE
Last Name:HENRY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-2203
Mailing Address - Country:US
Mailing Address - Phone:318-730-4853
Mailing Address - Fax:
Practice Address - Street 1:6211 MANOR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-2203
Practice Address - Country:US
Practice Address - Phone:318-730-4853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200194390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program