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General NPI Number Information
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NPI Number | 1386752293
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Entity Type | Individual
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Provider Name | JOHN R HENWOOD M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | CORNER OF ROUTE N12 AND N7
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504
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Country | US
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Telephone | 928-729-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 649
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504-0649
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Country | US
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Telephone | 316-686-6888
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Fax | 316-686-9358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-20156
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License Number State | KS
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