Provider Demographics
NPI:1558351965
Name:HENLEY, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
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 35808
Mailing Address - Street 2:
Mailing Address - City:TUSCON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740
Mailing Address - Country:US
Mailing Address - Phone:520-297-7826
Mailing Address - Fax:520-544-0060
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUSCON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-297-7826
Practice Address - Fax:520-544-0060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18559207ZP0102X
TXE2609207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ283896Medicaid
AZAZ0265650OtherBLUE CROSS BLUE SHIELD
AZ283896Medicaid
AZ22WCGRS03Medicare ID - Type Unspecified