Provider Demographics
NPI:1376516088
Name:HENDRICKS, JAMES WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARREN
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 1:2000 S WHEELING AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5639
Mailing Address - Country:US
Mailing Address - Phone:918-747-7544
Mailing Address - Fax:918-747-3952
Practice Address - Street 1:2000 S WHEELING AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5639
Practice Address - Country:US
Practice Address - Phone:918-747-7544
Practice Address - Fax:918-747-3952
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34782Medicare UPIN