Provider Demographics
NPI:1154463305
Name:HINES, JAMES EDWARD III (M D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:HINES
Suffix:III
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 N FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1012
Mailing Address - Country:US
Mailing Address - Phone:225-356-9775
Mailing Address - Fax:225-357-7768
Practice Address - Street 1:2149 N FOSTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1012
Practice Address - Country:US
Practice Address - Phone:225-356-9775
Practice Address - Fax:225-357-7768
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04639R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1195502Medicaid
LAC67476Medicare UPIN
LA52429Medicare PIN