Mark S Henderson M D P a

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

J4200 Issued in TX

Legal business name

MARK S HENDERSON M D P A

Practice address

1101 Raintree Cir
Suite 240
Allen, TX 75013-4922

Phone

(972) 908-3595

Fax

(972) 908-3596

NPI assigned

Jun 5, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Shea Henderson, MD

Title

Owner

Phone

(972) 908-3595

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1720247794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 RAINTREE CIR",
            "address_2": "SUITE 240",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750134922",
            "telephone_number": "972-908-3595",
            "fax_number": "972-908-3596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 RAINTREE CIR",
            "address_2": "SUITE 240",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750134922",
            "telephone_number": "972-908-3595",
            "fax_number": "972-908-3596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK S HENDERSON M D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "SHEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-908-3595",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "TX",
            "license": "J4200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113358901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "990010000",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8BF145",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Mann, LPC
• Simranjeet Mann
• Tinu Manthuruthil, PHARMD
• Kayla Mapps, M.D.
• Lacy Marchbanks, CCC-SLP
• Lynn Marlett, APN
• Marriage Fully Alive LLC
• Lauren Marshall, MS, LMFT
• Rychlend Carrington Noell Martin-Horne, PHARMD
• Arian Martin

• Surgery Physician in Allen, TX
• Providers in Allen, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.