Healthcare Provider Details

I. General information

NPI: 1437149598
Provider Name (Legal Business Name): TIMOTHY R. HINTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W BRIDGE ST
NEW LISBON WI
53950-1083
US

IV. Provider business mailing address

1040 DIVISION ST
MAUSTON WI
53948-1931
US

V. Phone/Fax

Practice location:
  • Phone: 608-562-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24174
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: