Healthcare Provider Details

I. General information

NPI: 1396900197
Provider Name (Legal Business Name): ROBERT DESHA HINES IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 MONTCLAIR RD SUITE 317
BIRMINGHAM AL
35213-1920
US

IV. Provider business mailing address

2000A SOUTHBRIDGE PKWY STE 300
BIRMINGHAM AL
35209-7718
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-5135
  • Fax:
Mailing address:
  • Phone: 205-871-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME157955
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD.30751
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: