Provider Demographics
NPI:1548238389
Name:HENDRICK, THOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:HENDRICK
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 1:403 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4717
Mailing Address - Country:US
Mailing Address - Phone:352-726-3646
Mailing Address - Fax:352-726-0079
Practice Address - Street 1:403 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4717
Practice Address - Country:US
Practice Address - Phone:352-726-3646
Practice Address - Fax:352-726-0079
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0046944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05836OtherBLUE CROSS BLUE SHIELD
FLD21061Medicare UPIN
FL38905Medicare PIN