Provider Demographics
NPI:1295790707
Name:HENDRICK, DANIEL JAY (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1805 POINT WEST PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124
Mailing Address - Country:US
Mailing Address - Phone:806-418-8620
Mailing Address - Fax:806-418-8626
Practice Address - Street 1:1805 POINT WEST PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124
Practice Address - Country:US
Practice Address - Phone:806-418-8620
Practice Address - Fax:806-418-8626
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL00025682207R00000X
TXM7257207R00000X, 207RN0300X
AL25682207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009989245Medicaid
TX8L2468OtherMEDICARE PTAN
NM93481586Medicaid
TX752684668OtherBCBS