Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

ROY RANDEL HENNEBERG, MD

Active

Specialist · COEUR D ALENE, ID

Registration Details

NPI Number: 1114956216
Provider Type: Individual
Gender: Male
NPI Issued: Jul 1, 2006 (19.837115373186 yrs)
Last Updated: May 14, 2020
License: M4722 (ID)

Practice Information

Address: 980 W IRONWOOD DR

SUITE 304

COEUR D ALENE, ID, 83814
Browse ID providers · Browse ZIP 83814
Phone: 2087654888
Fax: 2086678618
Primary Specialty: Specialist
174400000X

Other Specialist Providers in COEUR D ALENE, ID

Name	Credential	NPI
DR. LLOYD E. WITHAM	M.D.	1467448860
JOHN T GIESEN	M.D.	1093701492
MR. FREDRICK MARK OWSLEY	M.D.	1265413017
DR. DARYL K MACCARTER	M.D.	1740249275
MARK F BRINKMAN	M.D.	1205899671
DAVID K WINEINGER	M.D.	1972566214

Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.