Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 9278 | AL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 9278 | AL |
N | 207QS0010X | Family Doctor - Sports Medicine | 9278 | AL |
NPI | 1366523110 |
---|---|
Provider Name | Dr. Stephen Brown Henderson |
First Address | Guntersville, AL 35976-2206 |
Second Address | Guntersville, AL 35976-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 01/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
144705 | (05) | AL |
144869 | (05) | AL |
C72345 | (02) | AL |