Henderson, Mark Douglas

Henderson, Mark Douglas is an individual health care provider with primary practice located at 3851 Roger Brooke Dr , Fort Sam Houston TX 78234-4501. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Henderson, Mark Douglas can be contacted via phone (210) 916-8516.

Contact Information

Primary practice address
3851 Roger Brooke Dr Fort Sam Houston TX 78234-4501
Phone: (210) 916-8516
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 671885 Texas

Profile Details

NPI number 1861470148
LBN Legal business name Henderson, Mark Douglas
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 6th, 2006
Last updated Feb 2nd, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861470148 NPPES
Texas MEDICAID 191871609
Texas MEDICAID 1918716009
Texas MEDICAID 191871608

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