MEDICARE: JANE HENDERSON MD PA

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	207VG0400X	Gynecology Physician	ME43958	FL

General Provider Information

NPI Number	:	1225108392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE HENDERSON MD PA

Provider Business Mailing Address
First Line	:	960 37TH PL
Second Line	:	SUITE 102
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6586
Country	:	US
Telephone Number	:	772-770-6901
Fax Number	:	772-770-6902

Provider Business Practice Location Address
First Line	:	960 37TH PL
Second Line	:	SUITE 102
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6586
Country	:	US
Telephone Number	:	772-770-6901
Fax Number	:	772-770-6902

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. D JANE HENDERSON
Credential	:	MD
Telephone Number	:	772-770-6901

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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