Provider Demographics
NPI:1083145445
Name:HENDRICKS, LANDON ROBERT (MD)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:ROBERT
Last Name:HENDRICKS
Suffix:
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 1:848 N 980 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7709
Mailing Address - Country:US
Mailing Address - Phone:801-374-1999
Mailing Address - Fax:801-492-1991
Practice Address - Street 1:848 N 980 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7709
Practice Address - Country:US
Practice Address - Phone:801-374-1999
Practice Address - Fax:801-492-1991
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
UT11573816-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program