Provider Demographics
NPI:1013065101
Name:HENMAN, JAMES ORAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ORAL
Last Name:HENMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2414
Mailing Address - Country:US
Mailing Address - Phone:209-577-1667
Mailing Address - Fax:
Practice Address - Street 1:706 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2414
Practice Address - Country:US
Practice Address - Phone:209-577-1667
Practice Address - Fax:209-577-3805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPY6445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist