Provider Demographics
NPI:1598077703
Name:HENDRICKS, WESLEY AARON (DO)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:AARON
Last Name:HENDRICKS
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 1:600 NOKOMIS AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3209
Mailing Address - Country:US
Mailing Address - Phone:941-497-3327
Mailing Address - Fax:941-497-3328
Practice Address - Street 1:600 NOKOMIS AVE S STE 204
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3209
Practice Address - Country:US
Practice Address - Phone:941-497-3327
Practice Address - Fax:941-497-3328
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23844208600000X
FL17916208600000X
OH34.010524208600000X
OH390200000X
FLOS17916208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program