Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 24831 | NC |
NPI | 1063598423 |
---|---|
Provider Name | Robert Lee Hines |
First Address | Lumberton, NC 28358-3011 |
Second Address | Lumberton, NC 28358-2330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2006 |
Last Update Date | 10/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340020610 | RAILROAD MEDICARE (01) | NC |
42514 | BCBS (01) | NC |
8942514 | (05) | NC |
C82096 | (02) |