Provider Demographics
NPI:1528096823
Name:HENDERSON, D. JANE (MD)
Entity type:Individual
Prefix:DR
First Name:D.
Middle Name:JANE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:D.
Other - Middle Name:JANE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2859 SAINT BARTS SQ
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-7583
Mailing Address - Country:US
Mailing Address - Phone:772-559-8921
Mailing Address - Fax:772-559-8921
Practice Address - Street 1:2859 SAINT BARTS SQ
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-7583
Practice Address - Country:US
Practice Address - Phone:772-559-8921
Practice Address - Fax:772-559-8921
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43958207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3610087OtherEIN
FL79895ZMedicare PIN
FLC74817Medicare UPIN
FL59-3610087OtherEIN