Provider Demographics
NPI:1811194384
Name:HENKE, JEFFREY W (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:HENKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12201 MERIT DR STE 440
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3106
Mailing Address - Country:US
Mailing Address - Phone:214-823-5000
Mailing Address - Fax:214-824-7167
Practice Address - Street 1:12201 MERIT DR STE 440
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3106
Practice Address - Country:US
Practice Address - Phone:214-823-5000
Practice Address - Fax:214-824-7167
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ81256208600000X
TXP2670208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery