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NPI Code Detail

MEDICARE: DR. BRET D. HENRICKS M. D.

MEDICARE: DR. BRET D. HENRICKS M. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianME0070131FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3300062328OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
231772OTHERFLBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538150933
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRET D. HENRICKS M. D.
Provider Business Mailing Address
First Line : 2125 CRYSTAL GROVE DR
Second Line :
City : LAKELAND
State : FL
Zip : 33801-6875
Country : US
Telephone Number : 863-688-2334
Fax Number : 863-577-0299
Provider Business Practice Location Address
First Line : 1305 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4542
Country : US
Telephone Number : 863-688-2334
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 11/11/2013

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