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Individual

MAURICE O. HINTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1362
(601) 292-4592
Mailing address
PO BOX 23090, JACKSON, MS 39225-3090
(601) 968-1362
(601) 292-4592

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28232191A
IN
367500000X
Certified Registered Nurse Anesthetist
23373
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
R135040
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000001052254
ANTHEM PROVIDER NUMBER
IN
05
00117027
MS
05
1992831689
WI
05
201389760
IN
Enumeration date
02/26/2007
Last updated
01/23/2017
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