MEDICARE: DR. JUDSON SANDFORD 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	E1466	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8P1991	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720027576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDSON SANDFORD HENDERSON M.D

Provider Business Mailing Address
First Line	:	14700 FM 2100 RD
Second Line	:	SUITE A
City	:	CROSBY
State	:	TX
Zip	:	77532-9161
Country	:	US
Telephone Number	:	281-328-2568
Fax Number	:	281-328-2039

Provider Business Practice Location Address
First Line	:	14700 FM 2100 RD
Second Line	:	SUITE A
City	:	CROSBY
State	:	TX
Zip	:	77532-9161
Country	:	US
Telephone Number	:	281-328-2568
Fax Number	:	281-328-2039

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	05/16/2011

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