Provider Demographics
NPI:1710163050
Name:HENDERSON, TODD MARCOS (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MARCOS
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 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:363 SOUTHCREST CIR STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4737
Practice Address - Country:US
Practice Address - Phone:662-349-0488
Practice Address - Fax:662-349-5974
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12098207RC0200X, 207RP1001X, 207RS0012X
TN48203207RC0200X, 207RP1001X, 207RS0012X, 207RS0012X, 207RP1001X
MS22431207RP1001X, 207RS0012X, 207RC0200X
FLME100312207RS0012X
KY43800207RS0012X
LA204406207RS0012X
IN01068586A207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine