Provider Demographics
NPI:1275716664
Name:HENDERSON, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5232 COLLEYVILLE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7826
Mailing Address - Country:US
Mailing Address - Phone:817-912-9920
Mailing Address - Fax:817-498-0635
Practice Address - Street 1:5232 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7826
Practice Address - Country:US
Practice Address - Phone:817-912-9920
Practice Address - Fax:817-498-0635
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191385702Medicaid
TXTXB136713Medicare PIN