Individual
DR. MARK T HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
812 S 3RD ST, LOUISVILLE, KY 40203-2214
(502) 290-2501
(502) 287-1775
Mailing address
812 S 3RD ST, LOUISVILLE, KY 40203-2214
(502) 290-2501
(502) 287-1775
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
33009
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33009
KENTUCKY LICENSE
KY
05
—
64330095
—
KY
Enumeration date
06/08/2006
Last updated
12/19/2024
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