Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD449157 | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD449157 | PA |
NPI | 1427343201 |
---|---|
Provider Name | Joseph L Hines |
First Address | Altoona, PA 16601-4882 |
Second Address | Altoona, PA 16601-4882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2011 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES0000 | (02) | PA |