Mark Allen Hendrickson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

11659 Issued in AZ

Practice address

Rwbahc, BLDG 45001
Sierra Vista Cboc
Ft Huachuca, AZ 85613

Phone

(520) 533-9407

Fax

(520) 533-2568

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013931484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SOUTHERN AZ VA HEALTH CARE CTR",
            "address_2": "3601 S. 6TH AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857230001",
            "telephone_number": "520-533-9407",
            "fax_number": "520-533-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RWBAHC, BLDG 45001",
            "address_2": "SIERRA VISTA CBOC",
            "city": "FT HUACHUCA",
            "state": "AZ",
            "postal_code": "85613",
            "telephone_number": "520-533-9407",
            "fax_number": "520-533-2568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "MARK",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "11659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Eastep Gilstrap, RDH
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• Jolleen Gistinger Gray, RN
• Jackie Marie Harnois, RDH
• Brad Gordon Hawkins, PH.D.
• Rosa Alma Hernandez
• Serena Hernandez
• Deborah Holly, RN
• Bobbette Homesley
• Tamara Hopkins, RN

• Internal Medicine Physician in Ft Huachuca, AZ
• Providers in Ft Huachuca, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.