| Doctor Name: | MR. RANDALL WAYNE HENDERSON |
| NPI Number: | 1043334261 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BC-HIS |
| License Number: | 00729 |
| Business Practice Address: | 10404 W Coggins Dr Suite 110 Sun City, AZ - 853513437 |
| Business Phone Number: | 6239749666 |
| Business Fax Number: | 6239744813 |
| Mailing Address: | 2510 E Sunset Rd, Unit 5-260 LAS VEGAS |
| State: | NV |
| Postal Code: | 891203511 |
| Phone Number: | 7027980113 |
| Fax Number: | 8662915242 |
| NPI Enumeration Date: | 03/16/2007 |
| NPI Last Update Date: | 07/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 00729 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |