Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 39910 | SC |
NPI | 1013200328 |
---|---|
Provider Name | Jordan Andrew Henderson |
First Address | Myrtle Beach, SC 29572-4128 |
Second Address | Myrtle Beach, SC 29572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2011 |
Last Update Date | 22/06/2018 |