MEDICARE: GARY HENDERSON, MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0529	AZ

General Provider Information

NPI Number	:	1083895106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY HENDERSON, MD PC

Provider Business Mailing Address
First Line	:	1775 W SAINT MARYS RD STE 116
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2662
Country	:	US
Telephone Number	:	520-624-2471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 W SAINT MARYS RD STE 116
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2662
Country	:	US
Telephone Number	:	520-624-2471
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARY L HENDERSON
Credential	:	M.D.
Telephone Number	:	520-624-2471

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	11/16/2007

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