Provider Demographics
NPI:1720027576
Name:HENDERSON, JUDSON SANDFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:SANDFORD
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 FM 2100 RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-9161
Mailing Address - Country:US
Mailing Address - Phone:281-328-2568
Mailing Address - Fax:281-328-2039
Practice Address - Street 1:14700 FM 2100 RD
Practice Address - Street 2:SUITE A
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-9161
Practice Address - Country:US
Practice Address - Phone:281-328-2568
Practice Address - Fax:281-328-2039
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P1991OtherBCBS
TX127081106Medicaid
TX127081106Medicaid
TX680580620OtherTIN
TX8P1991OtherBCBS