Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD058456L | PA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | A41574 | CA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD058456L | PA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD058456L | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD058456L | PA |
NPI | 1821013145 |
---|---|
Provider Name | Dr. William L Hennrikus JR. |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 18/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A415740 | (05) | CA |
1022383500001 | (05) | PA |
GR0085690 | (05) | CA |
IO1641 | (02) | CA |