Healthcare Provider Details

I. General information

NPI: 1760595821
Provider Name (Legal Business Name): ROY H HINMAN MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARRICOLA AVE
ST AUGUSTINE FL
32080-4515
US

IV. Provider business mailing address

100 ARRICOLA AVE
ST AUGUSTINE FL
32080-4515
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-4368
  • Fax: 904-825-9107
Mailing address:
  • Phone: 904-825-4368
  • Fax: 904-825-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME56729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: