Provider Demographics
NPI:1215171020
Name:W. RAY HENDERSON,MD INC
Entity type:Organization
Organization Name:W. RAY HENDERSON,MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-346-3810
Mailing Address - Street 1:73180 EL PASEO
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4218
Mailing Address - Country:US
Mailing Address - Phone:760-346-3810
Mailing Address - Fax:760-346-3083
Practice Address - Street 1:73180 EL PASEO
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4218
Practice Address - Country:US
Practice Address - Phone:760-346-3810
Practice Address - Fax:760-346-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty