Provider Demographics
NPI:1750304804
Name:KENDRICK, DONALD TERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:TERRY
Last Name:KENDRICK
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 1:6298 W SARATOGA WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-6620
Mailing Address - Country:US
Mailing Address - Phone:850-217-2162
Mailing Address - Fax:
Practice Address - Street 1:6298 W SARATOGA WAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-6620
Practice Address - Country:US
Practice Address - Phone:850-217-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78959207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ124884Medicare PIN
G182170002Medicare UPIN