Roy Randel Henneberg, MD

NPI #1114956216 in Coeur D Alene, Idaho

Provider Information

NPI Number: 1114956216
Entity Type: Individual
Name: Roy Randel Henneberg, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: MD
Enumeration Date: Jul 1, 2006
Last Updated: May 14, 2020

Practice Location

Address: 980 W IRONWOOD DR
Address 2: SUITE 304
City: Coeur D Alene
State: Idaho
ZIP Code: 83814
Phone: (208) 765-4888

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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