Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | R3791 | KY |
NPI | 1104208776 |
---|---|
Provider Name | Dr. Thomas Keith Hines III |
First Address | Lexington, KY 40536-0293 |
Second Address | Lexington, KY 40536-0293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 24/06/2016 |