Provider Demographics
NPI:1083685788
Name:HINE, PETER W (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:HINE
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 1:4315 JAMES CASEY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3366
Mailing Address - Country:US
Mailing Address - Phone:512-443-3883
Mailing Address - Fax:512-445-6447
Practice Address - Street 1:4315 JAMES CASEY ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3366
Practice Address - Country:US
Practice Address - Phone:512-443-3883
Practice Address - Fax:512-445-6447
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133121704Medicaid
TX10011979OtherAMERIGROUP
TX80X861OtherBLUE CROSS BLUE SHIELD
TX10011979OtherAMERIGROUP