Provider Demographics
NPI:1619958667
Name:HYNICK, JAMES JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:HYNICK
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 1:301 E STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5217
Mailing Address - Country:US
Mailing Address - Phone:407-339-3524
Mailing Address - Fax:407-339-3832
Practice Address - Street 1:301 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5217
Practice Address - Country:US
Practice Address - Phone:407-339-3524
Practice Address - Fax:407-339-3832
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0003683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE32147Medicare UPIN
FL82108Medicare ID - Type Unspecified