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Organization
MA HENDRICKSON DO PA
Active
Organization
MA HENDRICKSON DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
M ALLISON HENDRICKSON DO (OWNER)
(817) 284-4081
Entity
Organization
Contact information
Practice address
4109 CAGLE DR, SUITE B, NORTH RICHLAND HILLS, TX 76180-8339
(817) 284-4081
(817) 284-3988
Mailing address
4109 CAGLE DR, SUITE B, NORTH RICHLAND HILLS, TX 76180-8339
(817) 284-4081
(817) 284-3988
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064MA
BCBS GROUP NUMBER
TX
01
—
110208679
MEDICARE RR GROUP NUMBER
—
05
—
172016101
—
TX
Enumeration date
05/15/2006
Last updated
08/13/2008
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