Provider Demographics
NPI:1396775698
Name:HENDERSON, JAMES ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROGER
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 1:25630 JIM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6835
Mailing Address - Country:US
Mailing Address - Phone:360-435-5270
Mailing Address - Fax:
Practice Address - Street 1:875 WESLEY ST
Practice Address - Street 2:SUITE 130
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1613
Practice Address - Country:US
Practice Address - Phone:360-435-6525
Practice Address - Fax:360-435-2634
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine