Provider Demographics
NPI:1245204817
Name:HENDRICKS, ROBERT E (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10251 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442-9717
Mailing Address - Country:US
Mailing Address - Phone:330-542-2315
Mailing Address - Fax:330-542-9700
Practice Address - Street 1:10251 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:44442-9717
Practice Address - Country:US
Practice Address - Phone:330-542-2315
Practice Address - Fax:330-542-9700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704036Medicaid
OHHE0394414Medicare ID - Type Unspecified
OH0704036Medicaid