Healthcare Provider Details

I. General information

NPI: 1275601544
Provider Name (Legal Business Name): PHILIP CARLTON HYDE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 NW 50TH ST
OKLAHOMA CITY OK
73118-4401
US

IV. Provider business mailing address

1117 NW 50TH ST
OKLAHOMA CITY OK
73118-4401
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-4435
  • Fax: 405-842-2846
Mailing address:
  • Phone: 405-842-4435
  • Fax: 405-842-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number215
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: