Healthcare Provider Details

I. General information

NPI: 1881029718
Provider Name (Legal Business Name): PATRICK MICHAEL HINES MSPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 S LAKESHORE DR #2
TEMPE AZ
85282-7161
US

IV. Provider business mailing address

1418 S COLT DR
GILBERT AZ
85296-7343
US

V. Phone/Fax

Practice location:
  • Phone: 480-456-8981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5487
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: