MEDICARE: DR. RICHARD LYLE 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	207X00000X	Orthopaedic Surgery Physician	MD00046369	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1437129947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LYLE HENDERSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 34439
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 CHASE AVE
Second Line	:	ORTHOPEDICS
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2924
Country	:	US
Telephone Number	:	509-522-5820
Fax Number	:	509-522-5570

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	05/25/2021

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