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General NPI Number Information
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NPI Number | 1992367056
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Entity Type | Individual
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Provider Name | JORDAN HYDE MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 02/01/2025
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Provider Practice Location Address
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Address Line | 833 CHESTNUT ST STE 740
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4409
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Country | US
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Telephone | 215-955-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 760 WOOD STREAM XING
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City | VALPARAISO
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State | IN
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Zip | 46385-2972
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Country | US
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Telephone | 219-973-9790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD486362
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License Number State | PA
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