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NPI Code Detail

MEDICARE: CLIFFORD LENNY HENDERSON MD

MEDICARE: CLIFFORD LENNY HENDERSON MD
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
1207R00000XInternal Medicine Physician26344OK
2207N00000XDermatology Physician26344OK

General Provider Information

NPI Number : 1477713642
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLIFFORD LENNY HENDERSON MD
Provider Business Mailing Address
First Line : 9720 BROADWAY EXT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-6315
Country : US
Telephone Number : 405-280-7546
Fax Number : 405-772-8674
Provider Business Practice Location Address
First Line : 9720 BROADWAY EXT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-6315
Country : US
Telephone Number : 405-280-7546
Fax Number : 405-772-8674
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2008
Last Update Date : 10/21/2020

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