Healthcare Provider Details

I. General information

NPI: 1598799884
Provider Name (Legal Business Name): ALLEN HENDRICKS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 HARRY HINES BLVD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3142
  • Fax:
Mailing address:
  • Phone: 214-648-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberP3345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: