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General NPI Number Information
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NPI Number | 1467525949
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Entity Type | Individual
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Provider Name | DAN J HENDRICKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 401 E HAWAII
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-302-2100
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Fax | 208-302-2125
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1026
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Country | US
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Telephone | 208-302-2100
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Fax | 208-302-2125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | M-9672
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | M-9672
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License Number State | ID
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