Provider Demographics
NPI:1871893156
Name:HENDERSON, JON P (DVM)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:P
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 E CENTRAL
Mailing Address - Street 2:PO BOX 968
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-0968
Mailing Address - Country:US
Mailing Address - Phone:405-247-5588
Mailing Address - Fax:
Practice Address - Street 1:1218 E CENTRAL
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-0968
Practice Address - Country:US
Practice Address - Phone:405-247-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4162174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian