Provider Demographics
NPI:1396717781
Name:HINTON, MARK ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLAN
Last Name:HINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 BERGQUIST DR
Mailing Address - Street 2:STE 1
Mailing Address - City:LACKLAND A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9907
Mailing Address - Country:US
Mailing Address - Phone:228-257-1978
Mailing Address - Fax:210-292-2520
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:STE 1
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:228-257-1978
Practice Address - Fax:210-292-2520
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK12162084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396717781Medicaid
TX1396717781OtherTRICARE
TX1396717781Medicaid
TX1396717781OtherTRICARE