Provider Demographics
NPI:1396848396
Name:HENDERSON, DARRELL L (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 SOUTH COLLEGE ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503
Mailing Address - Country:US
Mailing Address - Phone:337-233-5025
Mailing Address - Fax:337-233-5054
Practice Address - Street 1:1101 SOUTH COLLEGE ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-233-5025
Practice Address - Fax:337-233-5054
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02748R2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1103381Medicaid
LA52645B194Medicare PIN
LA1103381Medicaid