Provider Demographics
NPI:1477594984
Name:HENSON, BARNEY JERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARNEY
Middle Name:JERRY
Last Name:HENSON
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 1:66 HOSPITAL PLAZA
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452
Mailing Address - Country:US
Mailing Address - Phone:304-269-3108
Mailing Address - Fax:304-517-1570
Practice Address - Street 1:66 HOSPITAL PLAZA
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452
Practice Address - Country:US
Practice Address - Phone:304-269-3108
Practice Address - Fax:304-517-1570
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17607207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025331Medicaid
AL51512068OtherBCBS AL PIN
ALE56781Medicare UPIN
AL051512068Medicare PIN
AL051512068Medicaid