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General NPI Number Information
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NPI Number | 1881854206
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Entity Type | Organization
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Legal Business Name | W RAY HENDERSON MD INC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 73180 EL PASEO
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City | PALM DESERT
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State | CA
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Zip | 92260-4218
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Country | US
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Telephone | 760-346-3810
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Fax | 760-346-3083
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Provider Business Mailing Address
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Address Line | 73180 EL PASEO
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City | PALM DESERT
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State | CA
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Zip | 92260-4218
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Country | US
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Telephone | 760-346-3810
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Fax | 760-346-3083
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | W RAY HENDERSON
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Credential | MD
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Telephone | 760-346-3810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | C24144
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License Number State | CA
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