Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | H6284 | TX |
NPI | 1083615884 |
---|---|
Provider Name | Diana H Henderson |
First Address | San Antonio, TX 78229-3456 |
Second Address | San Antonio, TX 78229-3456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 27/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133549901 | (05) | TX |
F58099 | (02) | TX |