Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2012003318 | MO |
NPI | 1770748931 |
---|---|
Provider Name | Dr. Brian Matthew Hendricks |
First Address | Kansas City, MO 64118-4699 |
Second Address | Kansas City, MO 64118-4699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2008 |
Last Update Date | 16/01/2015 |