Provider Demographics
NPI:1740642966
Name:HENDERSON, MICHAEL LON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LON
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:PO BOX 9261
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-9261
Mailing Address - Country:US
Mailing Address - Phone:940-764-5200
Mailing Address - Fax:
Practice Address - Street 1:4327 BARNETT RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-2303
Practice Address - Country:US
Practice Address - Phone:940-764-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10395906-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine