Individual
DR. BRET D. HENRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1305 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4542
(863) 688-2334
Mailing address
2125 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
(863) 688-2334
(863) 577-0299
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME0070131
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250118000
—
FL
01
—
300062328
RR MEDICARE
FL
01
—
31772
BCBS
FL
Enumeration date
11/03/2005
Last updated
11/11/2013
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