Individual
DR. DOUGLAS L HENDRICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
280 NEWPORT CENTER DR, SUITE 120, NEWPORT BEACH, CA 92660-7526
(949) 640-9570
(949) 640-9569
Mailing address
280 NEWPORT CENTER DR, SUITE 120, NEWPORT BEACH, CA 92660-7526
(949) 640-9570
(949) 640-9569
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
G069421
CA
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
G069421
CA
208600000X
Surgery Physician
036151135
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036151135
—
IL
05
—
1922165703
—
WI
Enumeration date
01/02/2007
Last updated
08/31/2020
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