Individual
KATHRYN ANN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
19 MYRTLE ST, MEDFORD, OR 97504-7337
(541) 842-7626
(541) 842-7640
Mailing address
19 MYRTLE ST, MEDFORD, OR 97504-7337
(541) 842-7626
(541) 842-7640
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
D013513
OR
207Q00000X
Family Medicine Physician
Primary
DO13513
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023507000
BC/BS OF OREGON
OR
01
—
930079054
RAILROAD MEDICARE
—
01
—
97520A005
CHAMPUS
—
01
—
E68602
GROUP HEALTH
—
05
—
XPY185059
—
CA
Enumeration date
04/06/2006
Last updated
03/12/2013
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