Provider Demographics
NPI:1508196445
Name:METROPLEX DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:METROPLEX DERMATOLOGY, PLLC
Other - Org Name:DAVID HENSLEY, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-704-4777
Mailing Address - Street 1:300 W ARBROOK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3105
Mailing Address - Country:US
Mailing Address - Phone:817-704-4777
Mailing Address - Fax:
Practice Address - Street 1:300 W ARBROOK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3105
Practice Address - Country:US
Practice Address - Phone:817-704-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-27
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2489261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH41608Medicare UPIN