Provider Demographics
NPI:1073540571
Name:HENDRICK, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1939 WILMINGTON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6404
Mailing Address - Country:US
Mailing Address - Phone:970-980-6024
Mailing Address - Fax:877-489-6002
Practice Address - Street 1:1939 WILMINGTON DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6404
Practice Address - Country:US
Practice Address - Phone:970-980-6024
Practice Address - Fax:877-489-6002
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37885207R00000X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32801718Medicaid
CO636745OtherBCBS
WY117632300Medicaid
CO636745OtherBCBS
CO110215952Medicare ID - Type UnspecifiedRAILROAD
WY117632300Medicaid