Individual
DR. RANDALL STUART HINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 LAKELAND DR, FLOWOOD, MS 39232-7641
(601) 936-3650
(866) 491-0274
Mailing address
2500 LAKELAND DR, FLOWOOD, MS 39232-7641
(601) 936-3650
(866) 491-0274
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
12123
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116795
—
MS
01
—
08103071
UP MEDICAID GROUP PROV#
MS
05
—
09014712
—
MS
01
—
160039613
RR MEDICARE NUMBER
MS
01
—
512G700003
UP MEDICARE GROUP PROV#
MS
01
—
512I160006
MEDICARE PTAN
MS
Enumeration date
07/05/2006
Last updated
01/19/2022
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