Provider Demographics
NPI:1679909998
Name:HENDRICKS, JAMES JACKSON (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JACKSON
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 1:313 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-8660
Mailing Address - Country:US
Mailing Address - Phone:605-641-6822
Mailing Address - Fax:605-644-1939
Practice Address - Street 1:313 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-8660
Practice Address - Country:US
Practice Address - Phone:605-641-6822
Practice Address - Fax:605-644-1939
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD880207Q00000X
MN19170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine