Provider Demographics
NPI:1558440180
Name:HENDRIX, BARRY DEWANE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DEWANE
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2709 W KINGSHIGHWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2604
Mailing Address - Country:US
Mailing Address - Phone:870-236-7272
Mailing Address - Fax:870-236-7275
Practice Address - Street 1:2709 W KINGSHIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2604
Practice Address - Country:US
Practice Address - Phone:870-236-7272
Practice Address - Fax:870-236-7275
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE0965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR080127350OtherRAILROAD MEDICARE
AR130230001Medicaid
ARG33725Medicare UPIN