Individual
TRAVIS B HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4780
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558343061
—
SD
05
—
6004770
—
SD
01
—
S41965
PTAN
—
Enumeration date
11/18/2005
Last updated
06/12/2026
Update your record
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