Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 39672 | IA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 47669 | MN |
N | 207YS0123X | Facial Plastic Surgeon | 39672 | IA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 10222796-1205 | UT |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 39672 | IA |
NPI | 1558333179 |
---|---|
Provider Name | Douglas K Henstrom |
First Address | Layton, UT 84041-1187 |
Second Address | Iowa City, IA 52242-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
767689100 | (05) | MN |
I40187 | (02) |