Provider Demographics
NPI:1457469223
Name:HENDRIXSON, MARK NEAL (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:NEAL
Last Name:HENDRIXSON
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 1:707 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5011
Mailing Address - Country:US
Mailing Address - Phone:931-456-8435
Mailing Address - Fax:931-456-8496
Practice Address - Street 1:707 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5011
Practice Address - Country:US
Practice Address - Phone:931-456-8435
Practice Address - Fax:931-456-8496
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD021724207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4096802OtherBCBS
TN3091500Medicaid
TN9958819OtherCIGNA
TN4096802OtherBCBS
G04203Medicare UPIN
TN3091500Medicare ID - Type Unspecified