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Individual
DR. JACK GG HENDERSHOT JR.
Active
Individual
DR. JACK GG HENDERSHOT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
37324
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000129596
ANTHEM BCBS
OH
05
—
0277276
—
OH
01
—
037324
STATE LICENSE
OH
01
—
4281257
AETNA
OH
Enumeration date
08/03/2005
Last updated
03/07/2023
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