MEDICARE: DR. JAMES ROGER HENDERSON 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician		WA

General Provider Information

NPI Number	:	1396775698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ROGER HENDERSON M.D.

Provider Business Mailing Address
First Line	:	25630 JIM CREEK RD
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-6835
Country	:	US
Telephone Number	:	360-435-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 WESLEY ST
Second Line	:	SUITE 130
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1613
Country	:	US
Telephone Number	:	360-435-6525
Fax Number	:	360-435-2634

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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