Individual
MARK SHEA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
135 PLAZA DR, SUITE 202, SIKESTON, MO 63801-5136
(573) 472-6003
(573) 472-7159
Mailing address
135 PLAZA DR, SUITE 202, SIKESTON, MO 63801-5136
(573) 472-6003
(573) 472-7159
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J4200
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113358901
—
TX
05
—
113358905
—
TX
05
—
113358906
—
TX
05
—
113358907
—
TX
01
—
8BF145
BCBS
TX
01
—
990010000
MCARE RR
TX
Enumeration date
03/23/2006
Last updated
01/24/2012
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