Provider Demographics
NPI:1114125986
Name:H R HENDERSON MD P C
Entity Type:Organization
Organization Name:H R HENDERSON MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:541-485-8136
Mailing Address - Street 1:66 CLUB RD STE 210
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2460
Mailing Address - Country:US
Mailing Address - Phone:541-485-9136
Mailing Address - Fax:541-343-0058
Practice Address - Street 1:66 CLUB RD STE 210
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2460
Practice Address - Country:US
Practice Address - Phone:541-485-9136
Practice Address - Fax:541-343-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMDO79962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR08617-3Medicaid
OR08617-3Medicaid
ORC-92846Medicare UPIN