Provider Demographics
NPI:1285620732
Name:HENDRIX, BRYAN E (DPM)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:E
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 PURDUE RD
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6129
Mailing Address - Country:US
Mailing Address - Phone:317-471-8701
Mailing Address - Fax:317-471-8702
Practice Address - Street 1:8780 PURDUE RD
Practice Address - Street 2:SUITE # 7
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-6129
Practice Address - Country:US
Practice Address - Phone:317-471-8701
Practice Address - Fax:317-471-8702
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000510A207XX0004X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34567Medicare UPIN
201080CMedicare ID - Type Unspecified