Individual
DR. LARRY A HENDERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
92 RATLIFF ST, LUCEDALE, MS 39452-6537
(601) 947-8181
(601) 947-4411
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-8181
(601) 947-4411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19697
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009966685
—
AL
01
—
01-01886
UNITED HEALTH CARE
AL
05
—
09435313
—
MS
05
—
1502324
—
LA
05
—
270736500
—
FL
01
—
51523926
BLUE CROSS
AL
01
—
P00696992
PALMETTO GBA
MS
Enumeration date
06/06/2006
Last updated
12/24/2018
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