Individual
BRENT HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8801 S 101ST EAST AVE, TULSA, OK 74133-5716
(918) 294-4915
(918) 294-4947
Mailing address
1751 N ASPEN AVE, BROKEN ARROW, OK 74012-1197
(918) 794-6008
(918) 516-3447
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
3954
OK
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
3954
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200059770A
—
OK
01
—
900522349
MEDICARE GROUP PIN
OK
Enumeration date
05/31/2006
Last updated
04/19/2021
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