Provider Demographics
NPI:1225329584
Name:DEBORAH B HENDERSON, MD, PLLC
Entity Type:Organization
Organization Name:DEBORAH B HENDERSON, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-705-8505
Mailing Address - Street 1:372 COUNTY ROAD 381
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6826
Mailing Address - Country:US
Mailing Address - Phone:817-705-8505
Mailing Address - Fax:
Practice Address - Street 1:372 COUNTY ROAD 381
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6826
Practice Address - Country:US
Practice Address - Phone:817-705-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4467207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770765265OtherNPI INDIVIDUAL