MEDICARE: DR. ERIC L HENSEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	OS11121	FL
2	207Y00000X	Otolaryngology Physician	OS11121	FL

General Provider Information

NPI Number	:	1891864666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC L HENSEN DO

Provider Business Mailing Address
First Line	:	112 MEDICAL DR
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4780
Country	:	US
Telephone Number	:	903-729-0444
Fax Number	:	903-729-7765

Provider Business Practice Location Address
First Line	:	112 MEDICAL DR
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4780
Country	:	US
Telephone Number	:	903-729-0444
Fax Number	:	903-729-7765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/19/2018

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Directions to “ DR. ERIC L HENSEN DO” Practice Location

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