Provider Demographics
NPI:1265434674
Name:HINES, MARC E (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:E
Last Name:HINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N COURT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1911
Mailing Address - Country:US
Mailing Address - Phone:641-682-4978
Mailing Address - Fax:641-682-0722
Practice Address - Street 1:1313 N COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1911
Practice Address - Country:US
Practice Address - Phone:641-682-4978
Practice Address - Fax:641-682-0722
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA235512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3205153Medicaid
IA3205153Medicaid
IAI9881Medicare ID - Type Unspecified
IA3205153Medicaid