Healthcare Provider Details

I. General information

NPI: 1740258102
Provider Name (Legal Business Name): CARL HENRY HINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 HOMER RD
MINDEN LA
71055-3028
US

IV. Provider business mailing address

1114 HOMER RD
MINDEN LA
71055-3028
US

V. Phone/Fax

Practice location:
  • Phone: 318-371-1395
  • Fax: 318-377-5932
Mailing address:
  • Phone: 318-371-1395
  • Fax: 318-377-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLA015051
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: