Provider Demographics
NPI:1669730123
Name:HENDERSON, ELIZABETH BESTE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BESTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MEDICAL
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5392
Mailing Address - Country:US
Mailing Address - Phone:830-484-4604
Mailing Address - Fax:830-372-8905
Practice Address - Street 1:105 MEDICAL
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5392
Practice Address - Country:US
Practice Address - Phone:830-484-4604
Practice Address - Fax:830-372-8905
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10044572208600000X
TXQ8210208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX371473501Medicaid
TXBP10044572OtherPIT