Healthcare Provider Details

I. General information

NPI: 1285620732
Provider Name (Legal Business Name): BRYAN E HENDRIX DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 PURDUE RD SUITE # 7
INDIANAPOLIS IN
46268-6129
US

IV. Provider business mailing address

8780 PURDUE RD SUITE # 7
INDIANAPOLIS IN
46268-6129
US

V. Phone/Fax

Practice location:
  • Phone: 317-471-8701
  • Fax: 317-471-8702
Mailing address:
  • Phone: 317-471-8701
  • Fax: 317-471-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number07000510A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000510A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: