Provider Demographics
NPI:1881655454
Name:HINTON, JENNIFER M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HINTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1002 PERUQUE CROSSING CT
Mailing Address - Street 2:STE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2362
Mailing Address - Country:US
Mailing Address - Phone:636-294-5900
Mailing Address - Fax:636-294-5908
Practice Address - Street 1:1002 PERUQUE CROSSING CT
Practice Address - Street 2:STE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2362
Practice Address - Country:US
Practice Address - Phone:636-294-5900
Practice Address - Fax:636-294-5908
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2003008587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200190205Medicaid
MO939793595Medicare PIN