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Individual

BRYAN HENDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1701 E 23RD AVE, HUTCHINSON, KS 67502-1105
(620) 665-2587
Mailing address
6896 W SNOWVILLE RD, BRECKSVILLE, OH 44141-3214

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0425215
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
102509
BLUE CROSS BLUE SHIELD
KS
01
432140
FIRST GUARD
KS
Enumeration date
04/21/2006
Last updated
12/06/2007
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