Healthcare Provider Details

I. General information

NPI: 1427002336
Provider Name (Legal Business Name): RICHARD A HENDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 SLIDE RD
LUBBOCK TX
79424-5781
US

IV. Provider business mailing address

3420 22ND PL
LUBBOCK TX
79410-1314
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-8400
  • Fax: 806-783-3031
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK5115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: