Individual
CHUCK HENDERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 881-2448
Mailing address
704 WENONA WAY, EGLIN AFB, FL 32542-1646
(850) 651-2923
(850) 881-2923
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/05/2006
Last updated
07/08/2007
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