Individual
DR. MICHAEL O HENNEBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 S MCCLELLAN ST, SUITE 118, SPOKANE, WA 99204-2457
(509) 747-3147
(509) 747-0020
Mailing address
1404 E 64TH AVE, SPOKANE, WA 99223-6768
(509) 448-2558
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD 00013902
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22139
L&I
WA
01
—
340011620
RRB
WA
05
—
8250003
—
WA
Enumeration date
08/25/2006
Last updated
04/19/2012
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