Provider Demographics
NPI:1124010285
Name:HENDERSON, ROBERT R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2206
Mailing Address - Country:US
Mailing Address - Phone:615-327-1800
Mailing Address - Fax:615-327-4080
Practice Address - Street 1:1800 STATE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2206
Practice Address - Country:US
Practice Address - Phone:615-327-1800
Practice Address - Fax:615-327-4080
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4533207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2005268OtherBLUE CROSS
TN3143425Medicaid
TN3718779Medicare PIN
TNB02026Medicare UPIN