Provider Demographics
NPI:1841459369
Name:HENDRICK, RUSSELL GERARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:GERARD
Last Name:HENDRICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2633 NAPOLEON AVE STE 920
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-7408
Mailing Address - Country:US
Mailing Address - Phone:504-533-8848
Mailing Address - Fax:
Practice Address - Street 1:2633 NAPOLEON AVE STE 920
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-7408
Practice Address - Country:US
Practice Address - Phone:504-533-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206717208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00053345Medicaid
LA2384635Medicaid
LA378001ZKWLMedicare PIN
MS00053345Medicaid