MEDICARE: DR. PAMELA S 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
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	22689	AZ

General Provider Information

NPI Number	:	1982673208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA S HENDERSON MD

Provider Business Mailing Address
First Line	:	7425 E SHEA BLVD
Second Line	:	SUITE 105
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6411
Country	:	US
Telephone Number	:	480-596-6886
Fax Number	:	480-596-8989

Provider Business Practice Location Address
First Line	:	7425 E SHEA BLVD
Second Line	:	SUITE 105
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6411
Country	:	US
Telephone Number	:	480-596-6886
Fax Number	:	480-596-8989

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	10/10/2023

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