Provider Demographics
NPI:1053700161
Name:ROGER HENSON MD
Entity type:Organization
Organization Name:ROGER HENSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-477-4634
Mailing Address - Street 1:2995 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7393
Mailing Address - Country:US
Mailing Address - Phone:850-477-4634
Mailing Address - Fax:850-857-7782
Practice Address - Street 1:2995 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7393
Practice Address - Country:US
Practice Address - Phone:850-477-4634
Practice Address - Fax:850-857-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57047Medicare UPIN