Healthcare Provider Details

I. General information

NPI: 1255511788
Provider Name (Legal Business Name): NICHOLAS HUGHES HYDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 YGNACIO VALLEY RD SUITE B214
WALNUT CREEK CA
94596-3860
US

IV. Provider business mailing address

675 YGNACIO VALLEY RD SUITE B214
WALNUT CREEK CA
94596-3860
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-8346
  • Fax:
Mailing address:
  • Phone: 925-937-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberG062714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG062714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: