| Organization Name: | EAR NOSE AND THROAT MEDICAL CLINIC INC |
| NPI Number: | 1043212376 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD ALLEN HENDRICKS (PRESIDENT) |
| Mailing Address: | 1050 Las Tablas Rd Templeton |
| State: | CA US |
| Postal Code: | 934659729 |
| Phone Number: | 8054341836 |
| Fax Number: | 8054341590 |
| NPI Enumeration Date: | 05/31/2005 |
| NPI Last Update Date: | 12/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207YX0602X |
| License Number: | G19580 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Otolaryngology |
| Taxonomy Specialization: | Otolaryngic Allergy |
| Taxonomy Definition: | An otolaryngologist who specializes in the diagnosis and treatment of otolaryngic allergies and other allergic diseases. |