Provider Demographics
NPI:1649383845
Name:ROY H HINMAN MD PA
Entity Type:Organization
Organization Name:ROY H HINMAN MD PA
Other - Org Name:ISLAND DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HINMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:904-825-4368
Mailing Address - Street 1:100 ARRICOLA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4515
Mailing Address - Country:US
Mailing Address - Phone:904-825-4368
Mailing Address - Fax:904-825-9107
Practice Address - Street 1:100 ARRICOLA AVENUE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4515
Practice Address - Country:US
Practice Address - Phone:904-825-4368
Practice Address - Fax:904-825-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty