Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | PA9111716 | FL |
NPI | 1033684873 |
---|---|
Provider Name | Matthew Hendricks |
First Address | Maitland, FL 32751-7172 |
Second Address | Pembroke Pines, FL 33027-1778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2018 |
Last Update Date | 31/07/2019 |