Provider Demographics
NPI:1225035488
Name:HENDERSON, RODNEY D (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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:STE 2403
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7759
Practice Address - Country:US
Practice Address - Phone:928-726-2990
Practice Address - Fax:928-726-0786
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO105849207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ44983OtherSTATE LICENSE
MO105849OtherSTATE LICENSE
CAA67635OtherSTATE LICENSE
MO105849OtherSTATE LICENSE
G96726Medicare UPIN