Provider Demographics
NPI:1063418036
Name:HENDRICKS, GEORGE DAVID JR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:DAVID
Last Name:HENDRICKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4427
Mailing Address - Country:US
Mailing Address - Phone:817-332-2020
Mailing Address - Fax:817-332-4797
Practice Address - Street 1:1201 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4427
Practice Address - Country:US
Practice Address - Phone:817-332-2020
Practice Address - Fax:817-332-4797
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6734207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88Z910OtherBCBS
TX135564601Medicaid
TX135564603Medicaid
TX88Z910OtherBCBS
TX135564603Medicaid
TX135564601Medicaid
TX88Z910Medicare PIN