Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 5164 | TN |
Y | 208600000X | Surgeon | 5164 | TN |
NPI | 1003926478 |
---|---|
Provider Name | Leonard Harvey Hines |
First Address | Memphis, TN 38120-2112 |
Second Address | Memphis, TN 38119-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 12/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3154869 | (05) | TN |
B02543 | (02) | TN |