Provider Demographics
NPI:1477713642
Name:HENDERSON, CLIFFORD LENNY (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:LENNY
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 BROADWAY EXT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6315
Mailing Address - Country:US
Mailing Address - Phone:405-280-7546
Mailing Address - Fax:405-772-8674
Practice Address - Street 1:9720 BROADWAY EXT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6315
Practice Address - Country:US
Practice Address - Phone:405-280-7546
Practice Address - Fax:405-772-8674
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26344207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine