Individual
DR. ROBERT WILLIAM HENDERSON JR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1520 SAN PABLO ST # 1600, LOS ANGELES, CA 90033-5310
(323) 442-8541
(323) 442-8755
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-8541
(323) 442-8755
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
Primary
G25042
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G250420
BLUE SHIELD
CA
05
—
00G250420
—
CA
01
—
00G250420G56
CAL OPTIMA
CA
01
—
300046333
RAIL ROAD MEDICARE
CA
Enumeration date
07/11/2006
Last updated
04/23/2014
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