Basic Information
Provider Information | |||||||||
NPI: | 1437136504 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HENSLEE | ||||||||
FirstName: | TOM | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HENSLEE | ||||||||
OtherFirstName: | TOMMY | ||||||||
OtherMiddleName: | MAX | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DPM | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1302 NORTH STATE HWY 91 | ||||||||
Address2: |   | ||||||||
City: | DENISON | ||||||||
State: | TX | ||||||||
PostalCode: | 750201167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9034651054 | ||||||||
FaxNumber: | 9033278023 | ||||||||
Practice Location | |||||||||
Address1: | 1302 NORTH STATE HWY 91 | ||||||||
Address2: |   | ||||||||
City: | DENISON | ||||||||
State: | TX | ||||||||
PostalCode: | 750201167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9034651054 | ||||||||
FaxNumber: | 9033278023 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/29/2005 | ||||||||
LastUpdateDate: | 01/21/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 1116 | TX | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
ID | Type | State | Issuer | Description | 018692601 | 05 | TX |   | MEDICAID | TXB113323 | 01 | TX | TEXAS MEDICARE | OTHER |