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General NPI Number Information
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NPI Number | 1922165703
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Entity Type | Individual
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Provider Name | DOUGLAS L HENDRICKS MD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 280 NEWPORT CENTER DR SUITE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7526
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Country | US
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Telephone | 949-640-9570
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Fax | 949-640-9569
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Provider Business Mailing Address
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Address Line | 280 NEWPORT CENTER DR SUITE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7526
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Country | US
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Telephone | 949-640-9570
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Fax | 949-640-9569
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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 | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | G069421
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036151135
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G069421
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License Number State | CA
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