Healthcare Provider Details

I. General information

NPI: 1063498343
Provider Name (Legal Business Name): GREGORY EDMUND HYDE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 13TH ST
RUSHVILLE IN
46173-2126
US

IV. Provider business mailing address

1300 N MAIN ST
RUSHVILLE IN
46173-1198
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-7063
  • Fax: 765-932-7065
Mailing address:
  • Phone: 765-932-4111
  • Fax: 765-932-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM0115
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number01082170A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberM0115
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number01082170A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberM0115
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01082170A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: