Provider Demographics
NPI:1255337051
Name:HENDERSON, JOHN ABE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ABE
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:STE P-3200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1501
Mailing Address - Country:US
Mailing Address - Phone:409-899-4111
Mailing Address - Fax:409-899-5670
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:STE P-3200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1501
Practice Address - Country:US
Practice Address - Phone:409-899-4111
Practice Address - Fax:409-899-5670
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2024-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF9550208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133195101Medicaid
TX133195104Medicaid
HE08643K1OtherMEDICARE 2ND NUMBER
HE08643K1OtherMEDICARE 2ND NUMBER
TXD66540Medicare UPIN