Provider Demographics
NPI:1770697427
Name:HENTHORN, SHARON KAYE (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:KAYE
Last Name:HENTHORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-8617
Mailing Address - Country:US
Mailing Address - Phone:405-521-9958
Mailing Address - Fax:405-736-0497
Practice Address - Street 1:205 NW 35TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-8617
Practice Address - Country:US
Practice Address - Phone:405-521-9958
Practice Address - Fax:405-736-0497
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC59035Medicare UPIN