Provider Demographics
NPI:1457418915
Name:HENLEY, ALAN WADE (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:WADE
Last Name:HENLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:WADE
Other - Last Name:HENLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3825 OZARK ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7110
Mailing Address - Country:US
Mailing Address - Phone:479-271-7126
Mailing Address - Fax:
Practice Address - Street 1:3825 OZARK ACRES DR
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7110
Practice Address - Country:US
Practice Address - Phone:479-271-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8121207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32011Medicare UPIN