Provider Demographics
NPI:1043313141
Name:HINES, JOHN S (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:HINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:130 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:STE 2
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:936-291-8205
Mailing Address - Fax:936-291-3862
Practice Address - Street 1:130 MEDICAL CENTER PARKWAY
Practice Address - Street 2:STE 2
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-8205
Practice Address - Fax:936-291-3862
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16950Medicare UPIN
00JE83Medicare ID - Type Unspecified