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NPI Code Detail

MEDICARE: JAMES G HENDERSON MD

MEDICARE: JAMES G HENDERSON 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
1207Q00000XFamily Medicine Physician33996IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P01170195OTHERIARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
140379OTHERIAWELLMARK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750353223
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES G HENDERSON MD
Provider Business Mailing Address
First Line : 3415 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-6976
Country : US
Telephone Number : 563-742-4370
Fax Number : 309-558-7026
Provider Business Practice Location Address
First Line : 3415 53RD AVE
Second Line :
City : BETTENDORF
State : IA
Zip : 52722-6976
Country : US
Telephone Number : 563-742-4370
Fax Number : 309-558-7026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 02/05/2015

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