Individual
MARK DOUGLAS HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
3851 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4501
(210) 916-8516
Mailing address
1443 OSPREY HTS, SAN ANTONIO, TX 78260-6016
(830) 438-4525
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
671885
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1918716009
—
TX
05
—
191871608
—
TX
05
—
191871609
—
TX
Enumeration date
01/06/2006
Last updated
02/02/2012
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