Provider Demographics
NPI:1962451039
Name:HENDRIX, TINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:HENDRIX
Suffix:
Gender:F
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:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-879-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ351502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7086OtherHEALTH NET OF AZ
AZAZ0221810OtherBCBSAZ
AZZ25034Medicare PIN
AZP00321754Medicare PIN
AZ1Z7086OtherHEALTH NET OF AZ
AZZ109610Medicare PIN
AZZ121149Medicare PIN
AZZ074405Medicare PIN
AZP00237012Medicare PIN
F66013Medicare UPIN
AZZ109312Medicare PIN
AZZ121417Medicare PIN