Provider Demographics
NPI:1295863199
Name:HENDERSON, JASON S (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:N VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04962-0247
Mailing Address - Country:US
Mailing Address - Phone:207-873-6173
Mailing Address - Fax:
Practice Address - Street 1:6404 COTTON BAY DR N
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4528
Practice Address - Country:US
Practice Address - Phone:207-659-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4628208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist