Provider Demographics
NPI:1306801915
Name:HINES, DWIGHT A II (MD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:A
Last Name:HINES
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-2165
Mailing Address - Country:US
Mailing Address - Phone:817-866-2100
Mailing Address - Fax:817-866-2169
Practice Address - Street 1:203 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050-2165
Practice Address - Country:US
Practice Address - Phone:817-866-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5587207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115972504Medicaid
TX8509K4Medicare ID - Type Unspecified
TX115972504Medicaid