Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 01082170A | IN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | M0115 | TX |
NPI | 1063498343 |
---|---|
Provider Name | Gregory Edmund Hyde |
First Address | Rushville, IN 46173 |
Second Address | Rushville, IN 46173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
182063102 | (05) | TX |
E53771 | (02) | |
P00234692 | RAILROAD MEDICARE (01) |