Healthcare Provider Details

I. General information

NPI: 1376715672
Provider Name (Legal Business Name): GERALD JEROME HINES RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25038 E CANAL PL
AURORA CO
80018-1705
US

IV. Provider business mailing address

25038 E CANAL PL
AURORA CO
80018-1705
US

V. Phone/Fax

Practice location:
  • Phone: 303-907-4754
  • Fax:
Mailing address:
  • Phone: 303-907-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number1844
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: