Healthcare Provider Details

I. General information

NPI: 1437226008
Provider Name (Legal Business Name): HUGH RICHARD HENDERSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 CLUB ROAD SUITE 400
EUGENE OR
97401
US

IV. Provider business mailing address

44 CLUB ROAD SUITE 400
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-8136
  • Fax: 541-343-0058
Mailing address:
  • Phone: 541-485-8136
  • Fax: 541-343-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD07996
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier086173
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: