Provider Demographics
NPI:1013931484
Name:HENDRICKSON, MARK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:SOUTHERN AZ VA HEALTH CARE CTR
Mailing Address - Street 2:3601 S. 6TH AVE
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85723-0001
Mailing Address - Country:US
Mailing Address - Phone:520-533-9407
Mailing Address - Fax:520-533-2568
Practice Address - Street 1:RWBAHC, BLDG 45001
Practice Address - Street 2:SIERRA VISTA CBOC
Practice Address - City:FT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:520-533-9407
Practice Address - Fax:520-533-2568
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ11659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine