Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G1915 | TX |
Y | 208600000X | Surgeon | G1915 | TX |
NPI | 1013977677 |
---|---|
Provider Name | Dr. John C. Hendricks |
First Address | Dallas, TX 75284-7408 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807507 | BLUE SHIELD (01) | TX |
C16803 | (02) | TX |