Provider Demographics
NPI:1114915451
Name:HENDRICKS, MARIAN K (DO)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:K
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:5802 SARATOGA BLVD
Practice Address - Street 2:STE 150
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4252
Practice Address - Country:US
Practice Address - Phone:361-986-4600
Practice Address - Fax:361-985-0305
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2933207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157055804Medicaid
TX1L5763OtherMEDICARE
TX157055808Medicaid
TXP02601766OtherMCRR
TX00K51QOtherBCBS GROUP/COAST. BND FAM
TX157055807Medicaid
TX8G1442OtherBCBS