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ROY RANDEL HENNEBERG MD
NPI 1114956216
Specialist in Coeur D Alene, ID

Active since July 01, 2006
980 W IRONWOOD DR, SUITE 304, COEUR D ALENE, ID 83814(208) 765-4888(208) 667-8618 Get Directions Write a Review

NPPES record last updated: May 14, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Roy Randel Henneberg Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROY RANDEL HENNEBERG MD (NPI 1114956216) is an individual specialist in Coeur D Alene, Idaho, licensed in Idaho (M4722) and active in the NPI registry since July 2006. He maintains a secondary practice location in Coeur D Alene.

NPPES Registry Identity

NPI1114956216
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameROY RANDEL HENNEBERGCredential: MD
Location Address980 W IRONWOOD DR, SUITE 304Coeur D Alene, ID 83814
Mailing Address980 W Ironwood Dr Ste 201Coeur D Alene, ID 83814-2668 · (208) 765-4888 · Fax (208) 667-8618
Phone(208) 765-4888
Fax(208) 667-8618
Sole ProprietorNo
Enumeration DateJuly 1, 2006
Last NPPES UpdateMay 14, 2020
NPPES CertifiedMay 14, 2020
✔ NPI 1114956216 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in ID · M4722
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.
980 W IRONWOOD DR, Coeur D Alene, ID 83814
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Secondary Practice Location 1

Location 1980 W Ironwood Dr Ste 201Coeur D Alene, ID 83814-2668 · Phone (208) 765-4888 · Fax (208) 667-8618

Other Identifiers 1

Medicaid001684500ID

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
Pediatrics (Adolescent Medicine)
980 W IRONWOOD DR, STE 302
COEUR D'ALENE, ID 83814
Kootenai County (208) 292-5437
MARSTON T WESTBROOK , DDS, LLC
Dentist (Oral and Maxillofacial Surgery)
980 W IRONWOOD DR, SUITE 301
COEUR D ALENE, ID 83814
Kootenai County (208) 664-0844
MR. STEVEN I JESSUP M.A. LIC. ATC
Specialist/Technologist (Athletic Trainer)
980 W IRONWOOD DR, SUITE 207
COEUR D ALENE, ID 83814
Kootenai County (208) 770-2971
MATTHEW DAVID MCLAUGHLIN D.O.
Urology
980 W IRONWOOD DR, STE 104
COEUR D ALENE, ID 83814
Kootenai County (208) 667-0621
RONDA LYNN WILLIAMSON CNM
Advanced Practice Midwife
980 W IRONWOOD DR, STE 306
COEUR D ALENE, ID 83814
Kootenai County (208) 625-4970
MRS. SUZANNE KALEN EPPERSON ARNP-CNM
Midwife
980 W IRONWOOD DR
COEUR D ALENE, ID 83814
Kootenai County (208) 765-4888
APPLE FAMILY CARE PLLC
Family Medicine
980 W IRONWOOD DR, SUITE 201
COEUR D ALENE, ID 83814
Kootenai County (208) 292-1315
MR. FREDRICK MARK OWSLEY M.D.
Specialist
980 W IRONWOOD DR, STE 206
COEUR D ALENE, ID 83814
Kootenai County (208) 664-0165

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Roy Henneberg's NPI number?

The NPI number for Roy Henneberg is 1114956216. It was assigned to this individual provider in the NPPES registry on July 1, 2006.

Where is Roy Henneberg located?

Roy Henneberg practices at 980 W Ironwood Dr Suite 304, Coeur D Alene, ID 83814. The listed phone number is (208) 765-4888.

What is Roy Henneberg's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Roy Henneberg was last updated on May 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.