Provider Demographics
NPI:1922599422
Name:HENDRICKSON, TODD STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:STEPHEN
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HWY 110 N STE N
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3037
Mailing Address - Country:US
Mailing Address - Phone:903-839-1775
Mailing Address - Fax:903-839-1788
Practice Address - Street 1:601 HWY 110 N STE N
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3037
Practice Address - Country:US
Practice Address - Phone:903-839-1775
Practice Address - Fax:903-839-1788
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine