Provider Demographics
NPI:1316586589
Name:HINES, MERRILL ODOM III (MD)
Entity Type:Individual
Prefix:DR
First Name:MERRILL
Middle Name:ODOM
Last Name:HINES
Suffix:III
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 1:1861 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2001
Mailing Address - Country:US
Mailing Address - Phone:832-927-5000
Mailing Address - Fax:
Practice Address - Street 1:1861 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2001
Practice Address - Country:US
Practice Address - Phone:832-927-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4159207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology