Provider Demographics
| NPI: | 1336124155 |
|---|---|
| Name: | HYNDMAN, CATHERINE JEANNE (MD) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | CATHERINE |
| Middle Name: | JEANNE |
| Last Name: | HYNDMAN |
| Suffix: | |
| Gender: | F |
| 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: | PO BOX 130 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DILLINGHAM |
| Mailing Address - State: | AK |
| Mailing Address - Zip Code: | 99576 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 907-842-9218 |
| Mailing Address - Fax: | 907-842-9368 |
| Practice Address - Street 1: | 6000 KANAKANAK RD |
| Practice Address - Street 2: | |
| Practice Address - City: | DILLINGHAM |
| Practice Address - State: | AK |
| Practice Address - Zip Code: | 99576 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 907-842-5201 |
| Practice Address - Fax: | 907-842-9250 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2005-12-14 |
| Last Update Date: | 2011-12-15 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AK | 4489 | 207Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AK | MD4956 | Medicaid | |
| 8EZ334 | Medicare ID - Type Unspecified | ||
| 8EZ304 | Medicare ID - Type Unspecified | ||
| 8EZ224 | Medicare ID - Type Unspecified | ||
| 8EZ254 | Medicare ID - Type Unspecified | ||
| E62613 | Medicare UPIN | ||
| 8EZ344 | Medicare ID - Type Unspecified | ||
| 8EZ364 | Medicare ID - Type Unspecified | ||
| AK | MD4956 | Medicaid | |
| 8EZ234 | Medicare ID - Type Unspecified | ||
| 8EZ194 | Medicare ID - Type Unspecified | ||
| 8EZ245 | Medicare ID - Type Unspecified | ||
| 8EZ264 | Medicare ID - Type Unspecified | ||
| 8EZ394 | Medicare ID - Type Unspecified | ||
| 8EZ214 | Medicare ID - Type Unspecified | ||
| 8EZ274 | Medicare ID - Type Unspecified | ||
| 8EZ294 | Medicare ID - Type Unspecified | ||
| 8EZ314 | Medicare ID - Type Unspecified | ||
| 8EZ354 | Medicare ID - Type Unspecified | ||
| 8EZ204 | Medicare ID - Type Unspecified |
