Provider Demographics
NPI:1558301010
Name:HENDRY, JOHN EASTON III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EASTON
Last Name:HENDRY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:5525 DEWEY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3129
Mailing Address - Country:US
Mailing Address - Phone:916-961-1373
Mailing Address - Fax:916-961-1377
Practice Address - Street 1:5525 DEWEY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3129
Practice Address - Country:US
Practice Address - Phone:916-961-1373
Practice Address - Fax:916-961-1377
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG20774207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G207740Medicaid
CA00G207740Medicaid
00G207741Medicare ID - Type UnspecifiedPROVIDER NUMBER