Individual provider · NPI-1
Dr. Chase Douglas Henderson, M.D.
Surgery · Crestview, FL
NPI number1467988048
StatusActive
Last updated in NPPESJun 16, 2022
Details
- NPI
- 1467988048
- Entity type
- Individual (NPI-1)
- Name
- Dr. Chase Douglas Henderson
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 3, 2017
- Certification date
- Jun 16, 2022
- Last updated
- Jun 16, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | ME157502 | FL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
550 Redstone Ave W Ste 410Crestview, FL 32536-6457
Phone 850-306-2188
Mailing address
550 Redstone Ave W Ste 410Crestview, FL 32536-6457
Phone 850-306-2188
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