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Organization

JOHN M HENDERSON MD FAPA, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN M HENDERSON (PROVIDER)
(325) 617-7913
Entity
Organization

Contact information

Practice address
716 S KOENIGHEIM ST, SAN ANGELO, TX 76903-6770
(443) 829-5805
Mailing address
716 S KOENIGHEIM ST, SAN ANGELO, TX 76903-6770
(325) 617-7913
(325) 617-7917

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
D4150
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
D4150
TX MEDICAL LICENSE
TX
Enumeration date
10/22/2013
Last updated
03/18/2014
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