Individual
MARY SUSAN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2729 S HIGHWAY 65 82, LAKE VILLAGE, AR 71653-6136
(870) 265-9380
(870) 265-9389
Mailing address
2729 S HIGHWAY 65 82, LAKE VILLAGE, AR 71653-6136
(870) 265-9380
(870) 265-9389
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E-4988
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1381659
—
LA
Enumeration date
06/23/2006
Last updated
06/04/2014
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