Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 35124412 | OH |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 35-124412 | OH |
NPI | 1528200904 |
---|---|
Provider Name | Dr. Joseph Welles Henderson IV |
First Address | Richmond Heights, OH 44143-1192 |
Second Address | Richmond Heights, OH 44143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 12/01/2021 |