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General NPI Number Information
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NPI Number | 1285773960
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Entity Type | Organization
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Legal Business Name | MARK G HENDSERSON MD PC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2575 S CIMARRON RD SUITE 102
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City | LAS VEGAS
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State | NV
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Zip | 89117
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Country | US
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Telephone | 702-735-0077
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Fax | 702-866-0077
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Provider Business Mailing Address
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Address Line | 2575 S CIMARRON RD SUITE 102
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City | LAS VEGAS
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State | NV
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Zip | 89117
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Country | US
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Telephone | 702-735-0077
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Fax | 702-866-0077
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK G HENDERSON
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Credential | MD
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Telephone | 702-735-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 6058
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License Number State | NV
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