Provider Demographics
NPI:1750437554
Name:HENDRICKS, JOEL R (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:874 ED HALL DR STE 107
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1800
Mailing Address - Country:US
Mailing Address - Phone:972-932-5559
Mailing Address - Fax:972-932-5581
Practice Address - Street 1:874 ED HALL DR STE 107
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1800
Practice Address - Country:US
Practice Address - Phone:972-932-5559
Practice Address - Fax:972-932-5581
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9596208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098847905Medicaid
TX8BW402OtherBCBS
TX8BW402OtherBCBS
TX8F20627Medicare PIN