Provider Demographics
NPI:1407037237
Name:HENDRIX, JASON ERROL (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ERROL
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1436
Mailing Address - Country:US
Mailing Address - Phone:610-750-7891
Mailing Address - Fax:610-750-7896
Practice Address - Street 1:2208 QUARRY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609
Practice Address - Country:US
Practice Address - Phone:610-750-7891
Practice Address - Fax:610-750-7896
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015738207Q00000X
PAOS014279207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942442553OtherNPI RDA
PAP00600955OtherRAILROAD MEDICARE PTAN SIEGEL
PAP00619419OtherRAILROAD MEDICARE WEST DERM OF PA
DP7691OtherRAILROAD MEDICARE RDA
PA150588OtherMEDICARE RDA
DP7691OtherRAILROAD MEDICARE RDA