Individual
TRAVIS B HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1309 10TH AVE W, MOBRIDGE, SD 57601-1146
(605) 845-3692
(605) 845-8252
Mailing address
1309 10TH AVE W, MOBRIDGE, SD 57601-1146
(605) 845-3692
(605) 845-8252
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
11/18/2015
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