Healthcare Provider Details

I. General information

NPI: 1184327678
Provider Name (Legal Business Name): TROY HENDRICKSON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 BATES AVE
HOUSTON TX
77030-2698
US

IV. Provider business mailing address

1102 BATES AVE STE 1860
HOUSTON TX
77030-2633
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW8340
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: