Organization
MARK S HENDERSON M D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SHEA HENDERSON MD (OWNER)
(972) 908-3595
Entity
Organization
Contact information
Practice address
1101 RAINTREE CIR, SUITE 240, ALLEN, TX 75013-4922
(972) 908-3595
(972) 908-3596
Mailing address
1101 RAINTREE CIR, SUITE 240, ALLEN, TX 75013-4922
(972) 908-3595
(972) 908-3596
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J4200
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113358901
—
TX
01
—
8BF145
BCBS
TX
01
—
990010000
RAILROAD MEDICARE
TX
Enumeration date
06/05/2008
Last updated
07/15/2010
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