Individual
JOHN R HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
521 ADAMS AVE STE B, MORTON, WA 98356-9323
(360) 496-5145
Mailing address
PO BOX 1138, MORTON, WA 98356-0019
(360) 496-3688
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
E3472
AR
207Q00000X
Family Medicine Physician
Primary
OP61532255
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150835003
—
AR
01
—
5M478
BLUE CROSS BLUE SHIELD INDIVIDUAL
AR
01
—
P00115537
RAIL ROAD MEDICARE
AR
Enumeration date
04/08/2006
Last updated
07/17/2024
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