Provider Demographics
NPI:1588648208
Name:HENDERSON, ANITA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:RUTH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1249
Mailing Address - Country:US
Mailing Address - Phone:541-977-7754
Mailing Address - Fax:
Practice Address - Street 1:236 NW KINGWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1324
Practice Address - Country:US
Practice Address - Phone:541-548-7134
Practice Address - Fax:541-278-8350
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54649207Q00000X
ORMD27129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine