Individual
STEPHANIE RENEE CARSON HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 S MAIN ST, FORT WORTH, TX 76104-4804
(817) 702-6500
(817) 927-6559
Mailing address
PO BOX 732973, DALLAS, TX 75373-2973
(817) 702-2450
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
L4878
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578189-01
—
TX
05
—
157818903
—
TX
01
—
8A0452
BCBS
TX
01
—
8DP282
BCBS
TX
01
—
P01379268
RAILROAD MEDICARE
TX
Enumeration date
12/09/2005
Last updated
10/01/2018
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