Healthcare Provider Details

I. General information

NPI: 1720027576
Provider Name (Legal Business Name): JUDSON SANDFORD HENDERSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 FM 2100 RD SUITE A
CROSBY TX
77532-9161
US

IV. Provider business mailing address

14700 FM 2100 RD SUITE A
CROSBY TX
77532-9161
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-2568
  • Fax: 281-328-2039
Mailing address:
  • Phone: 281-328-2568
  • Fax: 281-328-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE1466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: