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General NPI Number Information
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NPI Number | 1619905940
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Entity Type | Individual
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Provider Name | JOHN P HENDERSON II MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 70 N STURMER ST
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City | BELINGTON
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State | WV
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Zip | 26250-7403
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Country | US
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Telephone | 304-823-2800
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Fax | 304-823-2703
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Provider Business Mailing Address
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Address Line | 70 N STURMER ST
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City | BELINGTON
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State | WV
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Zip | 26250-7403
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Country | US
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Telephone | 304-823-2800
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Fax | 304-823-2703
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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 | 17533
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License Number State | WV
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