MEDICARE: RICHARD W HENDERSHOT MD

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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	315081-1205	UT

General Provider Information

NPI Number	:	1518916782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD W HENDERSHOT MD

Provider Business Mailing Address
First Line	:	2965 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3602
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	8178 GORGOZA PINES RD UNIT 8H
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4607
Country	:	US
Telephone Number	:	801-965-3600
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	12/08/2025

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