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General NPI Number Information
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NPI Number | 1760798839
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Entity Type | Organization
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Legal Business Name | RAYMOND HENDERSON MD PA
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 1717 N FLAGLER DR SUITE 3
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6555
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Country | US
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Telephone | 561-804-9898
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Fax | 561-804-9049
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Provider Business Mailing Address
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Address Line | 1717 N FLAGLER DR SUITE 3
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6555
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Country | US
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Telephone | 561-804-9898
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Fax | 561-804-9049
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHANIE HENDERSON
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Credential |
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Telephone | 561-804-9898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME59588
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License Number State | FL
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