Provider Demographics
NPI:1457642092
Name:HENLEY, ERIC ZACHARY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ZACHARY
Last Name:HENLEY
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:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-321-2546
Mailing Address - Fax:501-321-1838
Practice Address - Street 1:225 MCAULEY CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6314
Practice Address - Country:US
Practice Address - Phone:501-321-2546
Practice Address - Fax:501-321-1838
Is Sole Proprietor?:No
Enumeration Date:2011-05-01
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8620208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205758001Medicaid