Healthcare Provider Details

I. General information

NPI: 1528096823
Provider Name (Legal Business Name): D. JANE HENDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: D. JANE HENDERSON MD

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 SAINT BARTS SQ
VERO BEACH FL
32967-7583
US

IV. Provider business mailing address

2859 SAINT BARTS SQ
VERO BEACH FL
32967-7583
US

V. Phone/Fax

Practice location:
  • Phone: 772-559-8921
  • Fax: 772-559-8921
Mailing address:
  • Phone: 772-559-8921
  • Fax: 772-559-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME43958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: