Basic Information
| Provider Information | |||||||||
| NPI: | 1396717781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINTON | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ALLAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 BERGQUIST DR | ||||||||
| Address2: | STE 1 | ||||||||
| City: | LACKLAND A F B | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782369907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282571978 | ||||||||
| FaxNumber: | 2102922520 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 BERGQUIST DR | ||||||||
| Address2: | STE 1 | ||||||||
| City: | LACKLAND A F B | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782369907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282571978 | ||||||||
| FaxNumber: | 2102922520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 12/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | K1216 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | K1216 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1396717781 | 05 | TX | MEDICAID | 1396717781 | 01 | TX | TRICARE | OTHER |