Provider Demographics
NPI:1407858392
Name:HENDRIX, THOMAS LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:HENDRIX
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 1:603 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1214
Mailing Address - Country:US
Mailing Address - Phone:512-352-7664
Mailing Address - Fax:512-365-5237
Practice Address - Street 1:603 MALLARD LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1214
Practice Address - Country:US
Practice Address - Phone:512-352-7664
Practice Address - Fax:512-365-5237
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0973207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123824803Medicaid
TX81H816Medicare ID - Type Unspecified
TX8F9816Medicare PIN
TXC16807Medicare UPIN