Henneberg, Roy Randel
Henneberg, Roy Randel is an individual health care provider with primary practice located at 980 W Ironwood Dr Suite 304, Coeur D Alene ID 83814. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Henneberg, Roy Randel can be contacted via phone (208) 765-4888.Contact Information
Primary practice address
980 W Ironwood Dr Suite 304
Coeur D Alene ID 83814
Phone: (208) 765-4888
Fax: (208) 667-8618
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | M4722 | Idaho |
Profile Details
| NPI number | 1114956216 |
|---|---|
| LBN Legal business name | Henneberg, Roy Randel |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 1st, 2006 |
| Last updated | May 14th, 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 | 1114956216 | NPPES |
| Idaho | MEDICAID | 001684500 |
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