Provider Demographics
NPI:1437136504
Name:HENSLEE, TOM M (DPM)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:M
Last Name:HENSLEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:TOMMY
Other - Middle Name:MAX
Other - Last Name:HENSLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1302 NORTH STATE HWY 91
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1167
Mailing Address - Country:US
Mailing Address - Phone:903-465-1054
Mailing Address - Fax:903-327-8023
Practice Address - Street 1:1302 NORTH STATE HWY 91
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1167
Practice Address - Country:US
Practice Address - Phone:903-465-1054
Practice Address - Fax:903-327-8023
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018692601Medicaid
TXTXB113323OtherTEXAS MEDICARE
TXTXB113323OtherTEXAS MEDICARE