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Individual
CHARLES EDWARD HENLEY
Active
Individual
CHARLES EDWARD HENLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3508
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100031740D
—
OK
01
—
P01588239
RAILROAD PTAN
IN
Enumeration date
02/03/2006
Last updated
03/14/2016
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