Individual
JON R HENDRICKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7303 ROGERS AVE, FORT SMITH, AR 72903-4112
(479) 478-7200
(479) 478-7225
Mailing address
PO BOX 11017, FORT SMITH, AR 72917-1017
(479) 478-7200
(478) 478-7225
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N7630
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17653000000
QUALCHOICE
—
01
—
52930
BLUE CROSS & BLUE SHIELD
AR
01
—
9718882
CIGNA
—
Enumeration date
03/24/2006
Last updated
07/08/2007
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