Provider Demographics
NPI:1427373398
Name:BENDRICK, GREGG ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:ALEXANDER
Last Name:BENDRICK
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:PO BOX 273
Mailing Address - Street 2:NASA DRYDEN FLIGHT RESEARCH CENTER M/S 4822
Mailing Address - City:EDWARDS
Mailing Address - State:CA
Mailing Address - Zip Code:93523-0273
Mailing Address - Country:US
Mailing Address - Phone:661-276-2258
Mailing Address - Fax:661-276-2392
Practice Address - Street 1:4822 MCKAY AVE
Practice Address - Street 2:NASA DRYDEN FLIGHT RESEARCH CENTER
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93523
Practice Address - Country:US
Practice Address - Phone:661-276-2258
Practice Address - Fax:661-276-2392
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG758972083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine