Individual
DR. RANDALL STUART HINES
Active
Individual
DR. RANDALL STUART HINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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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