Provider Demographics
NPI:1245225309
Name:HENDERSON, VICTOR R (MD)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:R
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 E SHOW LOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901
Mailing Address - Country:US
Mailing Address - Phone:928-537-6978
Mailing Address - Fax:928-537-4205
Practice Address - Street 1:2500 E HUNT DR
Practice Address - Street 2:STE H
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901
Practice Address - Country:US
Practice Address - Phone:928-537-6964
Practice Address - Fax:928-532-8798
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ269872085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ440264OtherAHCCCS
AZBH2334390OtherDEA
AZBH2334390OtherDEA
AZ24778Medicare ID - Type Unspecified