Provider Demographics
NPI:1215040803
Name:HENDEL, JERRY REED (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:REED
Last Name:HENDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 S CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2913
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-739-6718
Practice Address - Street 1:24 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1312
Practice Address - Country:US
Practice Address - Phone:320-589-4008
Practice Address - Fax:218-739-6718
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1008789OtherPREFERRED ONE NUMBER
ND12222Medicaid
MN49843HEOtherBCBS NUMBER
MN123435OtherU-CARE NUMBER
MNHP26572OtherHEALTHPARTNERS NUMBER
MN01-00798OtherMEDICA NUMBER FFMG
IA0967638Medicaid
NE41091744413Medicaid
MN336780100Medicaid
IA0967638Medicaid
ND12222Medicaid
MN336780100Medicaid
MN123435OtherU-CARE NUMBER
E59758Medicare UPIN