Provider Demographics
NPI:1477951846
Name:HENDERSON, PHILLIP (DVM)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SHAFFNER ST
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259-7002
Mailing Address - Country:US
Mailing Address - Phone:940-479-2782
Mailing Address - Fax:940-479-2675
Practice Address - Street 1:601 SHAFFNER ST
Practice Address - Street 2:
Practice Address - City:PONDER
Practice Address - State:TX
Practice Address - Zip Code:76259-7002
Practice Address - Country:US
Practice Address - Phone:940-479-2782
Practice Address - Fax:940-479-2675
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3671174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian