Healthcare Provider Details

I. General information

NPI: 1285748657
Provider Name (Legal Business Name): JONATHAN ALLEN HYDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD SUITE 830
MIAMI BEACH FL
33140-4556
US

IV. Provider business mailing address

4308 ALTON RD SUITE 830
MIAMI BEACH FL
33140-4556
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-0065
  • Fax: 305-532-9793
Mailing address:
  • Phone: 305-532-0065
  • Fax: 305-532-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0076225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: