Provider Demographics
NPI:1982699047
Name:HEDRICK, ARLIE W (DO)
Entity Type:Individual
Prefix:
First Name:ARLIE
Middle Name:W
Last Name:HEDRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:HEDRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3030 N CENTRAL AVE STE 1001
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2716
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:1955 W FRYE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6282
Practice Address - Country:US
Practice Address - Phone:480-728-3895
Practice Address - Fax:480-728-3610
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40812085R0001X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ864505OtherAHCCCS
AZD77420Medicare UPIN
AZP0449222Medicare PIN
AZ864505OtherAHCCCS