Provider Demographics
NPI:1144376419
Name:HENSLEY, DAVID RANDAL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDAL
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W ARBROOK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3105
Mailing Address - Country:US
Mailing Address - Phone:817-701-4777
Mailing Address - Fax:817-701-2323
Practice Address - Street 1:300 W ARBROOK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3105
Practice Address - Country:US
Practice Address - Phone:817-701-4777
Practice Address - Fax:817-701-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2489207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX270305706OtherTIN
TX00405QMedicare ID - Type Unspecified
TX270305706OtherTIN