Individual
MR. DAVID B HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 609-4000
Mailing address
PO BOX 40908, ATTN: MANAGED CARE PLANNING, FAYETTEVILLE, NC 28309-0908
(910) 615-6949
(910) 615-9761
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
100436
NC
363A00000X
Physician Assistant
Primary
100436
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10436
NORTH CAROLINA LICENSE
NC
01
—
1184615239
TRICARE
—
05
—
1184615239
—
SC
Enumeration date
10/28/2005
Last updated
07/12/2016
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