Individual
MICHAEL S LA RUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
PARTRICIA W HENDERSON DO PC, 1 ARH LANE, STE 800, LOW MOOR, VA 24457
(540) 862-6750
(540) 862-3742
Mailing address
PO BOX 629, CLIFTON FORGE, VA 24422-0629
(540) 862-6659
(540) 862-3742
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110001381
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972508059
—
VA
01
—
260538432
TRICARE
—
Enumeration date
06/16/2005
Last updated
08/12/2008
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