Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 2916 | TX |
NPI | 1679581078 |
---|---|
Provider Name | Dr. Gary W Henderson |
First Address | Plano, TX 75075-6242 |
Second Address | Plano, TX 75075-6242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 10/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T13782 | (02) | TX |