Provider Demographics
NPI:1023062056
Name:HENDRIX, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:HENDRIX
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 1:1223 S GEAR AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1682
Mailing Address - Country:US
Mailing Address - Phone:319-753-5177
Mailing Address - Fax:
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-753-5177
Practice Address - Fax:319-753-0893
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161158Medicaid
IAA01420Medicare UPIN