Provider Demographics
NPI:1750313896
Name:HENDRICK, ROBERT S JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:HENDRICK
Suffix:JR
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 1:3510 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3531
Mailing Address - Country:US
Mailing Address - Phone:504-779-5515
Mailing Address - Fax:504-779-5568
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-966-5187
Practice Address - Fax:318-329-3955
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1340162Medicaid
LA1340162Medicaid
LAC67247Medicare UPIN