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Individual
DAVID EUGENE HENDERSON
Active
Individual
DAVID EUGENE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000436A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087922
ANTHEM BCBS
—
05
—
100148890A
—
IN
01
—
257980A
MEDICARE DME
IN
01
—
35-1787467
TAX ID
—
01
—
411730
MEDICARE DME
IN
Enumeration date
07/08/2005
Last updated
06/27/2024
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