Provider Demographics
NPI:1023011616
Name:HINES, RONALD WAYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:HINES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 W 124TH LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2603
Mailing Address - Country:US
Mailing Address - Phone:405-659-1842
Mailing Address - Fax:913-261-9255
Practice Address - Street 1:4513 W 124TH LN
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-2603
Practice Address - Country:US
Practice Address - Phone:405-659-1842
Practice Address - Fax:913-261-9255
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113213ES0103X
MO2012014963213E00000X
KS12-00387213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731130289001OtherBLUE CROSS BLUE SHIELD
OK1295773398OtherGROUP NPI
OK0764240001OtherDMERC
OK731130289001OtherBLUE CROSS BLUE SHIELD
OK0764240001Medicare NSC
OKT40750Medicare UPIN
MOP01144993Medicare PIN