Provider Demographics
NPI:1689878258
Name:HENDRICKS, ROGER CHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHAD
Last Name:HENDRICKS
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 1:405 LONDONDERRY DR
Mailing Address - Street 2:STE 105
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7920
Mailing Address - Country:US
Mailing Address - Phone:254-776-0266
Mailing Address - Fax:
Practice Address - Street 1:405 LONDONDERRY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-776-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0026252207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3849179302OtherMYUTMB 3849179302-COMMERCIAL NUMBER