Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 5101025855 | MI |
N | 208600000X | Surgeon | 5101025855 | MI |
Y | 2086S0127X | Trauma Surgeon | 5101025855 | MI |
NPI | 1073877858 |
---|---|
Provider Name | Russell W Hyde |
First Address | Saginaw, MI 48602-5303 |
Second Address | Saginaw, MI 48601-2564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 01/04/2021 |