Individual
EDWIN R HENSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-2000
(580) 558-3408
Mailing address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-2000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
16952
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100030210C
SOONERCARE
OK
05
—
100030210D
—
OK
01
—
370015724
RAILROAD MEDICARE
OK
01
—
5312321
AETNA
OK
Enumeration date
09/13/2005
Last updated
03/21/2025
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