Individual
MR. GREGORY L HENDERSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
403 VONDERBURG DR, STE 101, BRANDON, FL 33511-5982
(813) 681-1122
(813) 684-4924
Mailing address
403 VONDERBURG DR, BRANDON, FL 33511-5982
(813) 681-1122
(813) 684-4924
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
ME0026952
FL
207W00000X
Ophthalmology Physician
Primary
ME26952
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0059735
GHI
NY
05
—
065634800
—
FL
01
—
0805213
UNITED HEALTHCARE
FL
01
—
2074202
AETNA
FL
01
—
4092871
AETNA
FL
01
—
53493
BCBS FLORIDA
FL
Enumeration date
07/07/2005
Last updated
09/10/2020
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