Provider Demographics
NPI:1629031950
Name:HINES, JOHN R (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:HINES
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 1:1000 W KINGSHIGHWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8592
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1300 W COURT ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4105
Practice Address - Country:US
Practice Address - Phone:870-236-4100
Practice Address - Fax:870-236-4122
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M478OtherMEDICARE INDIVIDUAL
AR5M478OtherBLUE CROSS BLUE SHIELD INDIVIDUAL
ARP00115537OtherRAIL ROAD MEDICARE
AR150835003Medicaid
AR5M478OtherMEDICARE INDIVIDUAL