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1659492627
JOHNNY (BLAINE) HENDERSON
FLAGSTAFF, AZ
NPI
1659492627
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: AZ 48599)
Enumeration Date
2007-04-03
Last Update Date
2015-12-18
Business Address
JOHNNY (BLAINE) HENDERSON MD
1200 N BEAVER ST
FLAGSTAFF, AZ 86001-3118
Phone number: 928-213-6415
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Mailing Address
JOHNNY (BLAINE) HENDERSON MD
1200 N BEAVER ST PAYER CREDENTIALING
FLAGSTAFF, AZ 86001-3118
Phone number: 928-773-2559
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