MEDICARE: DR. QUANG H HENDERSON SR. M.D.

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	207P00000X	Emergency Medicine Physician	K3906	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8P8506	OTHER	TX	BLUE CROSS & BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285715581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUANG H HENDERSON SR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 24125
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76124-1125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11490 WESTHEIMER RD STE 1000
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6853
Country	:	US
Telephone Number	:	832-699-3777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/07/2024

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