Provider Demographics
NPI:1801896881
Name:HINES, ELBERT EDWIN III (MD)
Entity type:Individual
Prefix:DR
First Name:ELBERT
Middle Name:EDWIN
Last Name:HINES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6263 POPLAR AVE
Mailing Address - Street 2:STE 1052
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4736
Mailing Address - Country:US
Mailing Address - Phone:901-761-6157
Mailing Address - Fax:901-761-4145
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:STE 1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4736
Practice Address - Country:US
Practice Address - Phone:901-761-6157
Practice Address - Fax:901-213-4513
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD15653207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN080040881OtherRAILROAD MEDICARE
TN2008944OtherBLUECROSS&BLUESHIELD
TN3017714Medicaid
TN3017714Medicare ID - Type Unspecified
TN080040881OtherRAILROAD MEDICARE