Provider Demographics
NPI:1306833041
Name:HENDERSON, ROBERT LAND JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAND
Last Name:HENDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1022 1ST ST N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8706
Mailing Address - Country:US
Mailing Address - Phone:205-621-9500
Mailing Address - Fax:205-621-9507
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 201
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-621-9500
Practice Address - Fax:205-621-9507
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025681207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532549OtherBCBS
AL051532549Medicare ID - Type UnspecifiedMEDICARE
I04450Medicare UPIN