Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 12-00387 | KS |
Y | 222Z00000X | Podiatrist | 12-00387 | KS |
N | 213E00000X | Podiatrist | 2012014963 | MO |
N | 222Z00000X | Podiatrist | 2012014963 | MO |
N | 213ES0103X | Foot & Ankle Surgery | 113 | OK |
NPI | 1023011616 |
---|---|
Provider Name | Dr. Ronald Wayne Hines |
First Address | Leawood, KS 66209-2603 |
Second Address | Leawood, KS 66209-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 11/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0764240001 | DMERC (01) | OK |
1295773398 | GROUP NPI (01) | OK |
731130289001 | BLUE CROSS BLUE SHIELD (01) | OK |
T40750 | (02) | OK |