Healthcare Provider Details

I. General information

NPI: 1346473782
Provider Name (Legal Business Name): GARY ROBERT HENSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GARY ROBERT HENSLEY M.D.

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 W DUNLAP AVE STE 290
PHOENIX AZ
85021-2759
US

IV. Provider business mailing address

2510 W DUNLAP AVE STE 290
PHOENIX AZ
85021-2759
US

V. Phone/Fax

Practice location:
  • Phone: 602-789-0344
  • Fax: 602-789-8389
Mailing address:
  • Phone: 602-789-0344
  • Fax: 602-789-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48173
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48173
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: