Provider Demographics
NPI:1013205863
Name:RODNEY D. HENDERSON, M.D.
Entity Type:Organization
Organization Name:RODNEY D. HENDERSON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-726-2990
Mailing Address - Street 1:9187 CLAIREMONT MESA BLVD
Mailing Address - Street 2:#6733
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1257
Mailing Address - Country:US
Mailing Address - Phone:928-726-2990
Mailing Address - Fax:928-726-0786
Practice Address - Street 1:2851 S AVENUE B
Practice Address - Street 2:SUITE 2403
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7726
Practice Address - Country:US
Practice Address - Phone:928-726-2990
Practice Address - Fax:928-726-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44983207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG96726Medicare UPIN