Provider Demographics
NPI:1366480618
Name:HENDERSON, JEAN CLAIRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CLAIRE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:C
Other - Last Name:WAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2658 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2802
Mailing Address - Country:US
Mailing Address - Phone:503-577-2183
Mailing Address - Fax:503-226-3169
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:SUNNYSIDE MEDICAL CENTER
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043137207L00000X
ORMD11868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F27922Medicare UPIN
8854779Medicare ID - Type Unspecified