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NPI Code Detail

MEDICARE: DR. JOSEPH BERNARD HENDERSON D.O.

MEDICARE: DR. JOSEPH BERNARD HENDERSON D.O.
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
1207RG0100XGastroenterology Physician2013-00623NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12013-00623OTHERNCLICENSE #
217953OTHERBCBS

General Provider Information

NPI Number : 1790963759
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH BERNARD HENDERSON D.O.
Provider Business Mailing Address
First Line : PO BOX 87112
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-7112
Country : US
Telephone Number : 412-527-8518
Fax Number : 910-323-3650
Provider Business Practice Location Address
First Line : 2041 VALLEYGATE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3745
Country : US
Telephone Number : 910-323-5203
Fax Number : 910-323-3650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2008
Last Update Date : 08/20/2013

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