Provider Demographics
NPI:1679546295
Name:HENDERSON, WILLIAM H (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
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 1:9239 WEST CENTER
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-354-8060
Mailing Address - Fax:402-354-8044
Practice Address - Street 1:9239 WEST CENTER
Practice Address - Street 2:SUITE 210
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-354-8060
Practice Address - Fax:402-354-8044
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE124752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074010401Medicaid
097808Medicare ID - Type Unspecified
NE47074010401Medicaid