Provider Demographics
NPI:1497714687
Name:HENDRICKSON, SCOTT E (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:HENDRICKSON
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 1:10210 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5834
Mailing Address - Country:US
Mailing Address - Phone:918-940-8500
Mailing Address - Fax:918-940-8399
Practice Address - Street 1:10210 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5834
Practice Address - Country:US
Practice Address - Phone:918-940-8500
Practice Address - Fax:918-940-8399
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3666207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH55651Medicare UPIN
OK100114020CMedicaid