Individual
DR. RANDAL HOLLIS HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2015 N. JEFFERSON ST., JACKSONVILLE, FL 32206
(904) 588-1800
Mailing address
P. O. BOX 116304, ATLANTA, GA 30368-6304
(904) 588-1800
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME36677
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000432264G
—
GA
05
—
2552299-00
—
FL
Enumeration date
03/31/2006
Last updated
10/20/2011
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