MEDICARE: DR. MERRILL ODOM HINES III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZF0201X	Forensic Pathology Physician	M4159	TX

General Provider Information

NPI Number	:	1316586589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERRILL ODOM HINES III MD

Provider Business Mailing Address
First Line	:	1861 OLD SPANISH TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2001
Country	:	US
Telephone Number	:	832-927-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1861 OLD SPANISH TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2001
Country	:	US
Telephone Number	:	832-927-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2020
Last Update Date	:	01/05/2020

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