Provider Demographics
NPI:1699750372
Name:HINES, STEPHEN LEE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:HINES
Suffix:
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 1:8205 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-2831
Mailing Address - Country:US
Mailing Address - Phone:214-724-6113
Mailing Address - Fax:
Practice Address - Street 1:122 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2382
Practice Address - Country:US
Practice Address - Phone:214-947-6700
Practice Address - Fax:214-947-6701
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9734207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156122701Medicaid
TX156122702Medicaid
TX170250801Medicaid
TX156122701Medicaid
TXB04631Medicare UPIN
TX8C7941Medicare ID - Type Unspecified