Individual
DAN J HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 E HAWAII, NAMPA, ID 83686
(208) 302-2100
(208) 302-2125
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-2100
(208) 302-2125
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
M-9672
ID
207RP1001X
Pulmonary Disease Physician
Primary
M-9672
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010158154
REGENCE
ID
05
—
807658900
—
ID
Enumeration date
11/15/2006
Last updated
11/10/2016
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