Provider Demographics
NPI:1477572089
Name:HENLEY, JAMES AARON (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AARON
Last Name:HENLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3633
Mailing Address - Country:US
Mailing Address - Phone:918-608-0348
Mailing Address - Fax:918-923-3884
Practice Address - Street 1:3863 S 103RD EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2443
Practice Address - Country:US
Practice Address - Phone:918-745-0800
Practice Address - Fax:918-745-0028
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4195208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200312980AMedicaid
OK200050460DMedicaid
OK200050460BMedicaid