Healthcare Provider Details

I. General information

NPI: 1316586589
Provider Name (Legal Business Name): MERRILL ODOM HINES III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2020
Last Update Date: 01/05/2020
Certification Date: 01/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1861 OLD SPANISH TRL
HOUSTON TX
77054-2001
US

IV. Provider business mailing address

1861 OLD SPANISH TRL
HOUSTON TX
77054-2001
US

V. Phone/Fax

Practice location:
  • Phone: 832-927-5000
  • Fax:
Mailing address:
  • Phone: 832-927-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberM4159
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: