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General NPI Number Information
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NPI Number | 1669546743
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Entity Type | Individual
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Provider Name | WIRT A HINES II MD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1121 E 3900 S SUITE C-125
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1214
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Country | US
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Telephone | 801-266-3400
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Fax | 801-266-3401
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Provider Business Mailing Address
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Address Line | 1121 E 3900 S SUITE C-125
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1214
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Country | US
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Telephone | 801-266-3400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1505831205
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License Number State | UT
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