Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 010026213 | MO |
NPI | 1306893300 |
---|---|
Provider Name | Dr. Richard Joseph Hendrickson |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 02/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306893300 | (05) | MO |
200665680B | (05) | KS |
200820250 | (05) | IN |
2659083 | (05) | OH |
H84824 | (02) |