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Individual

DR. DALE PRESTON HENKEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4562
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4562

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
G41486
CA
208000000X
Pediatrics Physician
Primary
MD150386
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1407812365
NBMC MAIN GROUP NPI
OR
01
161133
NBMC MAIN GROUP DMAP
OR
05
500630202
OR
01
93-0635514
NBMC MAIN GROUP TAX ID FOR BILLING
OR
01
MD150386
OREON MEDICAL LICENSE
OR
01
R0000WFBTV
NBMC MAIN GROUP MEDICARE
OR
Enumeration date
10/07/2008
Last updated
09/26/2011
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