Provider Demographics
NPI:1295180461
Name:HENDRICKS, BENJAMIN KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KEVIN
Last Name:HENDRICKS
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 1:1064 ISABELLA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-6187
Mailing Address - Country:US
Mailing Address - Phone:812-345-5422
Mailing Address - Fax:
Practice Address - Street 1:35 CASA ST STE 320
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1894
Practice Address - Country:US
Practice Address - Phone:805-316-3733
Practice Address - Fax:805-316-3738
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1295180461207T00000X
AZR75570207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery