Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME54625 | FL |
Y | 2080P0204X | Pediatric Emergency Doctor | ME54625 | FL |
NPI | 1114998200 |
---|---|
Provider Name | Dr. Phyllis Lillian Hendry |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 23/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000469829A | (05) | GA |
0549053-00 | (05) | FL |
D84349 | (02) | FL |