Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | F4065 | TX |
NPI | 1003854969 |
---|---|
Provider Name | Michael D Henderson |
First Address | Dallas, TX 75284-0853 |
Second Address | Dallas, TX 75240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 11/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100232103 | (05) | TX |
100232104 | (05) | TX |
139894507 | (05) | TX |
8X1974 | BCBS (01) | TX |
C16793 | (02) | TX |
P00387545 | RAILROAD (01) | TX |