Provider Demographics
NPI:1407991243
Name:HENSLEE, EDWIN E IV (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:E
Last Name:HENSLEE
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:918-488-6653
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:3504 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5073
Practice Address - Country:US
Practice Address - Phone:918-686-5399
Practice Address - Fax:918-684-3229
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK30388207V00000X
IN01063415207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology