Healthcare Provider Details

I. General information

NPI: 1407837479
Provider Name (Legal Business Name): THOMAS L HENDRIX, MD, PATRICIA B DEARMAN, MD, W THOMAS KITTLEMAN, MD,P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MALLARD LN
TAYLOR TX
76574-1214
US

IV. Provider business mailing address

603 MALLARD LN
TAYLOR TX
76574-1214
US

V. Phone/Fax

Practice location:
  • Phone: 512-352-7664
  • Fax: 512-365-5237
Mailing address:
  • Phone: 512-352-7664
  • Fax: 512-365-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS LAWRENCE HENDRIX
Title or Position: PRESIDENT
Credential: M.D.
Phone: 512-352-7664