Healthcare Provider Details

I. General information

NPI: 1609282250
Provider Name (Legal Business Name): JASON H HYDE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD BLDG 1130
LUKE AIR FORCE BASE AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD BLDG 1130
LUKE AIR FORCE BASE AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-2296
  • Fax: 541-885-6608
Mailing address:
  • Phone: 623-856-2296
  • Fax: 541-885-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number1304
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: