Healthcare Provider Details

I. General information

NPI: 1336364215
Provider Name (Legal Business Name): JACK TERRELL HINKLE DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 S BLUFF ST STE 6
ST GEORGE UT
84770-3593
US

IV. Provider business mailing address

595 S BLUFF ST STE 6
ST GEORGE UT
84770-3593
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-5851
  • Fax: 435-628-5852
Mailing address:
  • Phone: 435-628-5851
  • Fax: 435-628-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4903985-1204
License Number StateUT

VIII. Authorized Official

Name: DR. JACK HINKLE
Title or Position: DO
Credential: DO
Phone: 435-628-5851