Provider Demographics
NPI:1346400249
Name:HENDERSON, DAVID DUFF (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DUFF
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1033 EL CAMINO REAL
Mailing Address - Street 2:P. O. BOX 7001
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:805-468-2005
Mailing Address - Fax:805-468-2138
Practice Address - Street 1:1033 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-468-2005
Practice Address - Fax:805-468-2138
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1373822084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry