Provider Demographics
NPI:1144218652
Name:HINKLE, JACK TERRELL (DO)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:TERRELL
Last Name:HINKLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 S BLUFF ST STE 6
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3593
Mailing Address - Country:US
Mailing Address - Phone:435-628-5851
Mailing Address - Fax:435-628-5852
Practice Address - Street 1:595 S BLUFF ST STE 6
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3593
Practice Address - Country:US
Practice Address - Phone:435-628-5851
Practice Address - Fax:435-628-5852
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007259207Q00000X
UT4903985 1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853830844OtherMICHIGAN BC
MI1744090Medicaid
MI1744090Medicaid
UTP43850001Medicare PIN
UT005718001Medicare PIN