Provider Demographics
NPI:1760507933
Name:HENDERSON, PATRICK CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:CHARLES
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 1:1605 E RIVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5971
Mailing Address - Country:US
Mailing Address - Phone:520-296-5437
Mailing Address - Fax:520-296-9683
Practice Address - Street 1:1605 E RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5971
Practice Address - Country:US
Practice Address - Phone:520-296-5437
Practice Address - Fax:520-296-9683
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ40293207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ340375Medicaid