Henderson, Gregory Philip
Henderson, Gregory Philip is an individual health care provider with primary practice located at 1441 Avocado Ave Ste 409 , Newport Beach CA 92660-7705. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Henderson, Gregory Philip can be contacted via phone (949) 640-4501.Contact Information
Primary practice address
1441 Avocado Ave Ste 409
Newport Beach CA 92660-7705
Phone: (949) 640-4501
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | A125261 | California |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | A125261 | California |
Profile Details
| NPI number | 1619109519 |
|---|---|
| LBN Legal business name | Henderson, Gregory Philip |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 11th, 2009 |
| Last updated | Jun 18th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619109519 | NPPES |
| Minnesota | MEDICAID | ENROLLED | |
| Minnesota | Other | P00940083 | |
| Minnesota | MEDICAID | ENROLLED |
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