Healthcare Provider Details

I. General information

NPI: 1023455169
Provider Name (Legal Business Name): JOHN P HINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 FLOWOOD DR STE 303
FLOWOOD MS
39232-9306
US

IV. Provider business mailing address

2550 FLOWOOD DR STE 303
FLOWOOD MS
39232-9306
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-7700
  • Fax: 601-709-7701
Mailing address:
  • Phone: 480-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number49529
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR73740
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number26630
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: