Provider Demographics
NPI:1063588184
Name:HENZLER, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:HENZLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E DIMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2010
Mailing Address - Country:US
Mailing Address - Phone:907-565-6000
Mailing Address - Fax:907-565-6001
Practice Address - Street 1:1100 E DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2010
Practice Address - Country:US
Practice Address - Phone:907-565-6000
Practice Address - Fax:907-565-6001
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1142322084N0400X
MEMD207632084N0400X
KY487142084N0400X
NMMD2015-09042084N0400X
WAMD000359382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1727366Medicaid
WA7094329Medicaid
AB21917Medicare ID - Type Unspecified
F87057Medicare UPIN