Individual
JASON PAUL HENDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 FERRY ST, LAFAYETTE, IN 47904
(765) 448-8000
(765) 447-9749
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048930A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000190918
ANTHEM PROVIDER NUMBER
IN
01
—
10825254
CAQH NUMBER
IN
05
—
200283760
—
IN
01
—
9397123
PHCS PID NUMBER
IN
Enumeration date
03/17/2006
Last updated
01/13/2021
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