Healthcare Provider Details

I. General information

NPI: 1841459369
Provider Name (Legal Business Name): RUSSELL GERARD HENDRICK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 NAPOLEON AVE STE 920
NEW ORLEANS LA
70115-7408
US

IV. Provider business mailing address

2633 NAPOLEON AVE STE 920
NEW ORLEANS LA
70115-7408
US

V. Phone/Fax

Practice location:
  • Phone: 504-533-8848
  • Fax:
Mailing address:
  • Phone: 504-533-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number206717
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number206717
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: