MEDICARE: DR. JEFFREY DEAN HYDE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	200160	LA
2	207RI0011X	Interventional Cardiology Physician	200160	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	292990	OTHER	LA	WELLCARE
3	P00282533	OTHER	LA	PALMETTO GBA 10066

General Provider Information

NPI Number	:	1336143841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY DEAN HYDE M.D.

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	257-655-7272
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	7777 HENNESSY BLVD
Second Line	:	SUITE 1000
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4300
Country	:	US
Telephone Number	:	225-767-3900
Fax Number	:	225-766-2226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	03/26/2021

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Directions to “ DR. JEFFREY DEAN HYDE M.D.” Practice Location

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