Provider Demographics
NPI:1760595821
Name:HINMAN, ROY H (MD PA)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:H
Last Name:HINMAN
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARRICOLA AVE
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 AVE
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09732OtherBLUE CROSS/BLUE SHIELD FL
069752OtherAETNA
069752OtherAETNA
FL09732AMedicare PIN