Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 0101239563 | VA |
NPI | 1558341024 |
---|---|
Provider Name | Johnny Hyde JR. |
First Address | Richmond, VA 23226-1934 |
Second Address | Richmond, VA 23226-1934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 22/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010266271 | (05) | VA |
10008181 | OPTIMA (01) | VA |
BH7180223 | DEA (01) | OK |
C06778 | GROUP PTAN (01) | VA |
H92182 | (02) | VA |
P00360751 | RAILROAD MEDICARE (01) | VA |