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General NPI Number Information
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NPI Number | 1831415793
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Entity Type | Organization
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Legal Business Name | HENDERSON FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 105 N HIGH ST
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City | HENDERSON
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State | TX
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Zip | 75652-3133
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Country | US
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Telephone | 903-235-0086
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Fax | 903-657-1674
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Provider Business Mailing Address
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Address Line | 105 N HIGH ST
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City | HENDERSON
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State | TX
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Zip | 75652-3133
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Country | US
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Telephone | 903-235-0086
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Fax | 903-657-1674
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Authorized Official
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Title or Position | OWNER
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Name | TAD TITLOW
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Credential | FNP
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Telephone | 903-235-0086
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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 | L1106
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License Number State | TX
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