Individual
DR. BENNETT ELLEN HARGROVE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4102 24TH ST STE 406, LUBBOCK, TX 79410-1804
(806) 725-5790
(806) 725-5791
Mailing address
2215 NASHVILLE AVE, LUBBOCK, TX 79410-1105
(806) 725-5844
(806) 723-6532
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
Q9635
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043658677
BCBS NM CENTENNIAL
NM
01
—
1043658677
FIRSTCARE
TX
05
—
373353701
—
TX
05
—
44159340
—
NM
01
—
582317YKT8
TX MEDICARE
TX
01
—
8GX035
BCBS TX
TX
Enumeration date
06/05/2013
Last updated
04/30/2018
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