Individual
ROY HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14535A HAZEL DELL PKWY, CARMEL, IN 46033-9401
(317) 705-4360
(317) 705-4361
Mailing address
PO BOX 869, NOBLESVILLE, IN 46061-0869
(317) 770-6900
(317) 770-6911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01075456A
IN
207Q00000X
Family Medicine Physician
036-104711
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01075456A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
036104711
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104711
—
IL
05
—
201291730
—
IN
Enumeration date
07/10/2006
Last updated
07/21/2022
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