Provider Demographics
NPI:1144450792
Name:HENDERSON, PHILLIP (DO)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5555
Mailing Address - Fax:251-660-5559
Practice Address - Street 1:75 S UNIVERSITY BLVD
Practice Address - Street 2:UCOM 6000B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0002
Practice Address - Country:US
Practice Address - Phone:251-660-5555
Practice Address - Fax:251-660-5559
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1151207R00000X
ALDO.1151207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine