# GREGORY L HENDERSON MD FACS INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GREGORY L HENDERSON MD FACS INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568130441
- **Legal business name:** GREGORY L HENDERSON MD FACS INC
- **Authorized official:** MR. GREGORY L HENDERSON SR. MD (PRESIDENT)
- **Authorized official phone:** (813) 681-1122

## Contact information

- **Practice address:** 5800 49TH ST. N., STE 5108, ST. PETERBURG, FL 33709-2146
- **Practice address phone:** (727) 390-3937
- **Practice address fax:** (727) 390-3940
- **Mailing address:** 403 VONDERBURG DR, BRANDON, FL 33511-5982
- **Mailing address phone:** (813) 681-1122
- **Mailing address fax:** (813) 684-4924

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2021
- **Last updated:** 09/03/2021