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NPI Code Detail

MEDICARE: RANDALL D HENDERSON DO PA

MEDICARE: RANDALL D HENDERSON DO 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
1207Q00000XFamily Medicine PhysicianL1340TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100925UOTHERTXBCBS GROUP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871779090
Entity Type Code : Organization
Provider Name (Legal Business Name) : RANDALL D HENDERSON DO PA
Provider Business Mailing Address
First Line : 202 E JEFFERSON AVE
Second Line :
City : WHITNEY
State : TX
Zip : 76692-2398
Country : US
Telephone Number : 254-694-2221
Fax Number : 254-694-9978
Provider Business Practice Location Address
First Line : 202 E JEFFERSON AVE
Second Line :
City : WHITNEY
State : TX
Zip : 76692-2398
Country : US
Telephone Number : 254-694-2221
Fax Number : 254-694-9978
Authorized Official
Title or Position : BUSINESS OFFICE MANAGER
Name : MRS. LINDA J HALL
Credential :
Telephone Number : 254-694-2221
Provider Enumeration Date : 01/17/2008
Last Update Date : 06/09/2011

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Directions to “RANDALL D HENDERSON DO PA ” Practice Location

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