1689993198 NPI number — DR. BRAINARD WILLEM HINES PHD

Table of content: DR. BRAINARD WILLEM HINES PHD (NPI 1689993198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689993198 NPI number — DR. BRAINARD WILLEM HINES PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINES
Provider First Name:
BRAINARD
Provider Middle Name:
WILLEM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689993198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2355 NE OCEAN BLVD
Provider Second Line Business Mailing Address:
#38B
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34996-2945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-804-4205
Provider Business Mailing Address Fax Number:
305-675-9254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2355 NE OCEAN BLVD
Provider Second Line Business Practice Location Address:
#38B
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34996-2945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-804-4205
Provider Business Practice Location Address Fax Number:
305-675-9254
Provider Enumeration Date:
05/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MHC 0612 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)