Provider Demographics
NPI:1497846901
Name:HENDERSON, BRIAN HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HOWARD
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 1:50 S SAN MATEO DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3857
Mailing Address - Country:US
Mailing Address - Phone:650-348-0893
Mailing Address - Fax:650-348-3958
Practice Address - Street 1:50 S SAN MATEO DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3857
Practice Address - Country:US
Practice Address - Phone:650-348-0893
Practice Address - Fax:650-348-3958
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31854207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31854OtherCALIFORNIA STATE LICENCE
00G318540Medicare ID - Type Unspecified