Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G74422 | CA |
N | 111NI0900X | Internist | G74422 | CA |
Y | 207RX0202X | Medical Oncology | G74422 | CA |
NPI | 1093730293 |
---|---|
Provider Name | Dr. Isaac C. Henderson |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94115-3010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 18/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G744220 | (05) | CA |
B73313 | (02) | CA |