Healthcare Provider Details

I. General information

NPI: 1245204817
Provider Name (Legal Business Name): ROBERT E HENDRICKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10251 MAIN ST
NEW MIDDLETOWN OH
44442-9717
US

IV. Provider business mailing address

10251 MAIN ST
NEW MIDDLETOWN OH
44442-9717
US

V. Phone/Fax

Practice location:
  • Phone: 330-542-2315
  • Fax: 330-542-9700
Mailing address:
  • Phone: 330-542-2315
  • Fax: 330-542-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOH2094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: