Individual
LORRE T HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 MEDICAL PLAZA DR STE 220, ROSEVILLE, CA 95661-3088
(916) 773-7920
(916) 773-7921
Mailing address
PO BOX 255668, SACRAMENTO, CA 95865-5668
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
C41977
CA
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
C41977
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C419770
—
CA
Enumeration date
10/10/2006
Last updated
03/17/2018
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