Individual
DR. BRETT R HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3850 E LOHMAN AVE, SUITE C, LAS CRUCES, NM 88011-8288
(575) 522-1974
(575) 522-5209
Mailing address
PO BOX 13668, LAS CRUCES, NM 88013-3668
(575) 522-1974
(575) 522-5209
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
2001-213
NM
208600000X
Surgery Physician
2001-213
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F1792
—
NM
01
—
NM019Y53
BCBS OF NEW MEXICO
NM
01
—
P00459212
RR MEDICARE
NM
Enumeration date
01/19/2007
Last updated
06/26/2015
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