Provider Demographics
NPI:1518980556
Name:HINMAN, JON A (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:A
Last Name:HINMAN
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:PO BOX 113390
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-3390
Mailing Address - Country:US
Mailing Address - Phone:907-278-2741
Mailing Address - Fax:907-743-8284
Practice Address - Street 1:3035 PALMER-WASILLA HWY
Practice Address - Street 2:UNIT 501
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-8330
Practice Address - Fax:907-357-8733
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK4112207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD41121Medicaid
AK160669Medicare ID - Type Unspecified
AKMD41121Medicaid
CACE607ZMedicare PIN