MEDICARE: DR. SANDRA ELIZABETH HENDERSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	41526	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053360834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA ELIZABETH HENDERSON M.D.

Provider Business Mailing Address
First Line	:	1300 RIVERSIDE AVE STE 102
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4353
Country	:	US
Telephone Number	:	970-224-1670
Fax Number	:	970-495-6218

Provider Business Practice Location Address
First Line	:	2025 BIGHORN RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-229-9800
Fax Number	:	970-229-1421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/30/2021

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