Provider Demographics
NPI:1619951803
Name:HINES, MICHAEL WESTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WESTON
Last Name:HINES
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 1:6400 NEWBERRY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6603
Mailing Address - Country:US
Mailing Address - Phone:352-333-5050
Mailing Address - Fax:352-248-2228
Practice Address - Street 1:6400 W NEWBERRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6605
Practice Address - Country:US
Practice Address - Phone:352-333-5050
Practice Address - Fax:352-248-2228
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045028207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25161000Medicaid
C16956Medicare UPIN
FL25161000Medicaid