Provider Demographics
NPI:1184717373
Name:HENDRIX, STEPEHN L (MD)
Entity type:Individual
Prefix:
First Name:STEPEHN
Middle Name:L
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 1:4541 N DAVIS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-494-9000
Mailing Address - Fax:850-479-4258
Practice Address - Street 1:4541 N DAVIS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-494-9000
Practice Address - Fax:850-479-4258
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0083311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0088311OtherSTATE LICENSE
P00068279OtherMEDICARE RAILROAD
FL274011700Medicaid
FM05019OtherBCBS OF FL
FLBH5555579OtherDEA
FM05019OtherBCBS OF FL
FLME0088311OtherSTATE LICENSE
FLF20208Medicare UPIN
FL274011700Medicaid