Individual
GREGORY PHILIP HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1441 AVOCADO AVE STE 409, NEWPORT BEACH, CA 92660-7705
(949) 640-4501
Mailing address
1441 AVOCADO AVE STE 409, NEWPORT BEACH, CA 92660-7705
(949) 640-4501
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
A125261
CA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
A125261
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P00940083
RAILROAD MEDICARE
MN
Enumeration date
08/11/2009
Last updated
06/18/2020
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