Individual
JEFFREY LYNN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
390 N MAIN ST, BOUNTIFUL, UT 84010-6046
(801) 292-6100
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 292-6100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
8294005-1205
UT
207P00000X
Emergency Medicine Physician
M4145
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181360201
—
TX
01
—
181360202
CSHCN
TX
01
—
8V1546
BCBS
TX
Enumeration date
05/03/2006
Last updated
04/20/2017
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