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General NPI Number Information
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NPI Number | 1760726897
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Entity Type | Individual
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Provider Name | JEROD L HINES M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1202 E LOCUST ST
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City | EMMETT
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State | ID
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Zip | 83617-2715
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Country | US
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Telephone | 208-365-3563
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 W IDAHO BLVD
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City | EMMETT
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State | ID
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Zip | 83617-9644
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Country | US
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Telephone | 208-954-1762
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD214337
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M-11820
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License Number State | ID
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