Healthcare Provider Details

I. General information

NPI: 1316900905
Provider Name (Legal Business Name): WILLIAM G HENDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE SUITE A
ALBUQUERQUE NM
87111-3575
US

IV. Provider business mailing address

3825 EUBANK BLVD NE STE A
ALBUQUERQUE NM
87111-3559
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-8575
  • Fax: 505-292-8409
Mailing address:
  • Phone: 505-292-8575
  • Fax: 505-292-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73-138
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: