Individual
COREY H HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 WATERMAN WAY, TAVARES, FL 32778
(407) 886-8164
(407) 475-0280
Mailing address
PO BOX 1409, EUSTIS, FL 32727-1409
(352) 742-7735
(352) 742-2289
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME85553
FL
207RI0200X
Infectious Disease Physician
ME85553
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265554300
—
FL
Enumeration date
07/08/2005
Last updated
05/27/2022
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