Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G069421 | CA |
Y | 208600000X | Surgeon | G069421 | CA |
N | 2082S0105X | Plastic Hand Surgeon | G069421 | CA |
N | 208200000X | Surgeon | 036151135 | IL |
N | 208600000X | Surgeon | 036151135 | IL |
NPI | 1922165703 |
---|---|
Provider Name | Dr. Douglas L Hendricks |
First Address | Newport Beach, CA 92660-7526 |
Second Address | Newport Beach, CA 92660-7526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G694210 | (02) | CA |
036151135 | (05) | IL |
1922165703 | (05) | WI |
E57869 | (02) | CA |