Provider Demographics
NPI:1376533455
Name:HENSON, LYMAN KELTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LYMAN
Middle Name:KELTON
Last Name:HENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:213 ST ROBERT BLVD
Mailing Address - Street 2:STE 3-105
Mailing Address - City:ST ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3323
Mailing Address - Country:US
Mailing Address - Phone:573-774-2951
Mailing Address - Fax:573-774-2951
Practice Address - Street 1:126 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8952
Practice Address - Country:US
Practice Address - Phone:573-596-1680
Practice Address - Fax:573-596-0423
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-10485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine