Provider Demographics
NPI:1598720492
Name:HENDERSON, PATRICK EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EDWARD
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E SAN ANTONIO ST STE 508E
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6020
Mailing Address - Country:US
Mailing Address - Phone:361-485-0051
Mailing Address - Fax:361-579-8685
Practice Address - Street 1:605 E SAN ANTONIO ST STE 508E
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6020
Practice Address - Country:US
Practice Address - Phone:361-485-0051
Practice Address - Fax:361-579-8685
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXW1287207Y00000X
WAOP60414976207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXW1287OtherLICENSE
CO31899OtherSTATE LICENSE NUMBER
CO01318997Medicaid
COE00741Medicare UPIN