Provider Demographics
NPI:1104863935
Name:HENDLER, NEDDA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:NEDDA
Middle Name:BETH
Last Name:HENDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-294-1044
Mailing Address - Fax:801-292-8369
Practice Address - Street 1:390 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6046
Practice Address - Country:US
Practice Address - Phone:801-294-1044
Practice Address - Fax:801-292-8369
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3382771205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057086Medicaid
UT942854057086Medicaid
UTB62863Medicare UPIN