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NPI Code Detail

MEDICARE: GREGORY L HENDERSON MD FACS INC

MEDICARE: GREGORY L HENDERSON MD FACS INC
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
1152W00000XOptometrist
2207W00000XOphthalmology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
35019195OTHERFLAETNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306839725
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREGORY L HENDERSON MD FACS INC
Provider Business Mailing Address
First Line : 403 VONDERBURG DR
Second Line :
City : BRANDON
State : FL
Zip : 33511-5982
Country : US
Telephone Number : 813-681-1122
Fax Number : 813-684-4924
Provider Business Practice Location Address
First Line : 403 VONDERBURG DR
Second Line :
City : BRANDON
State : FL
Zip : 33511-5982
Country : US
Telephone Number : 813-681-1122
Fax Number : 813-684-4924
Authorized Official
Title or Position : PRESIDENT
Name : MR. GREGORY L HENDERSON SR.
Credential : MD
Telephone Number : 813-681-1122
Provider Enumeration Date : 08/31/2005
Last Update Date : 07/21/2022

Similar Medicare Providers

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Practice Location Address:
403 VONDERBURG DR , STE 101
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1154328920 — DAVID S NICHOLS M.D.
Practice Location Address:
403 VONDERBURG DR , STE 101
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1427055227 — MR. GREGORY L HENDERSON SR. M.D.
Practice Location Address:
403 VONDERBURG DR , STE 101
BRANDON, FL
33511-5982
Practice Phone: 813-681-1122
Practice Fax: 813-684-4924
1598762395 — LESLIE R ALONZO III O.D.
Practice Location Address:
403 VONDERBURG DR , STE 101
BRANDON, FL
33511-5982
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Practice Fax: 813-684-4924
1194723742 — WILLIAM A REEVES M.D.
Practice Location Address:
403 VONDERBURG DR
BRANDON, FL
33511-5982
Practice Phone: 813-681-1122
Practice Fax: 813-684-4924
1659371441 — MARGUERITE MARY KOHLHEPP MD
Practice Location Address:
403 VONDERBURG DR
BRANDON, FL
33511-5982
Practice Phone: 813-681-1122
Practice Fax: 813-684-4924

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