Active NPI
Robert Henderson, MD
- Anesthesiology Physician
- Elk City, OK
National Provider Identifier
1417927468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 16816
- Practice address
- 1705 W 2ND St
Elk City, OK 73644-4455 - Phone
- (580) 225-2511
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 16816 | OK | Primary |
Addresses
Primary practice location
1705 W 2ND St
Elk City, OK 73644-4455
Mailing address
PO Box 47686
Wichita, KS 67201-7686
Phone (316) 685-6236
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100096130A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210723200000",
"number": "1417927468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 47686",
"city": "WICHITA",
"state": "KS",
"postal_code": "672017686",
"telephone_number": "316-685-6236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1705 W 2ND ST",
"city": "ELK CITY",
"state": "OK",
"postal_code": "736444455",
"telephone_number": "580-225-2511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "ROBERT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2008-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OK",
"license": "16816",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100096130A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.