Provider Demographics
NPI:1609904788
Name:HENSLER, JOHN EARLE (M D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EARLE
Last Name:HENSLER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 N 40TH ST
Mailing Address - Street 2:SUITE # 125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2148
Mailing Address - Country:US
Mailing Address - Phone:602-951-7141
Mailing Address - Fax:602-957-0074
Practice Address - Street 1:5070 N 40TH ST
Practice Address - Street 2:SUITE # 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2148
Practice Address - Country:US
Practice Address - Phone:602-951-7141
Practice Address - Fax:602-957-0074
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5346261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service