Provider Demographics
NPI:1407977432
Name:HENDRIX, RICHARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
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 1:4825 S HIGHWAY 95
Mailing Address - Street 2:SUITE 5 #503
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-8315
Mailing Address - Country:US
Mailing Address - Phone:928-788-1900
Mailing Address - Fax:928-788-2048
Practice Address - Street 1:1611 JOY LN
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-8807
Practice Address - Country:US
Practice Address - Phone:928-788-1900
Practice Address - Fax:928-788-2048
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0760200OtherBCBS PROVIDER ID
AZ7256452OtherAETNA PROVIDER ID
AZ873861Medicaid
AZ919836OtherCIGNA PROVIDER ID
AZAZ0760200OtherBCBS PROVIDER ID
AZ873861Medicaid
AZP00142564Medicare ID - Type UnspecifiedRAILROAD MEDICARE ID
AZ83530Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL