Provider Demographics
NPI:1700838570
Name:HENDERSON, DAVID V (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
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:PO BOX C
Mailing Address - Street 2:312 SO MAPLE ST
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032
Mailing Address - Country:US
Mailing Address - Phone:785-448-6988
Mailing Address - Fax:785-448-2243
Practice Address - Street 1:312 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032
Practice Address - Country:US
Practice Address - Phone:785-448-6988
Practice Address - Fax:785-448-2243
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B68831Medicare UPIN
KS104234Medicare ID - Type Unspecified