Provider Demographics
NPI:1548358013
Name:HINOJOSA, JOSE L (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:HINOJOSA
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 1:510 W RADIO LN
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-4011
Mailing Address - Country:US
Mailing Address - Phone:620-442-2100
Mailing Address - Fax:620-442-6041
Practice Address - Street 1:510 W RADIO LN
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-4011
Practice Address - Country:US
Practice Address - Phone:620-442-2100
Practice Address - Fax:620-442-6041
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36883207Q00000X
OK29630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F74WOtherBLUE CROSS BLUE SHIELD
TXMDH0405OtherWORKER'S COMP
TX135140504Medicaid
00F74WMedicare Oscar/Certification
TX00F74WOtherBLUE CROSS BLUE SHIELD
TXC16961Medicare UPIN