Individual
MARVIN GRAVES HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6901 N 72 STREET, OMAHA, NE 68122
(402) 778-9738
(402) 334-2849
Mailing address
PO BOX 34310, OMAHA, NE 68134
(402) 778-9738
(402) 334-2849
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
16232
NE
207L00000X
Anesthesiology Physician
24054
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2213876
—
IA
05
—
47-0550438-13
—
NE
Enumeration date
08/25/2006
Last updated
02/19/2010
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