MEDICARE: DAVID E HYDE MD

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	207Q00000X	Family Medicine Physician	35055374	OH

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	000000025871	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1508866302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID E HYDE MD

Provider Business Mailing Address
First Line	:	888 DAYTON ST
Second Line	:	SUITE 200
City	:	YELLOW SPRINGS
State	:	OH
Zip	:	45387-1777
Country	:	US
Telephone Number	:	937-767-7291
Fax Number	:	937-767-1302

Provider Business Practice Location Address
First Line	:	888 DAYTON ST
Second Line	:	SUITE 200
City	:	YELLOW SPRINGS
State	:	OH
Zip	:	45387-1777
Country	:	US
Telephone Number	:	937-767-7291
Fax Number	:	937-767-1302

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/13/2015

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Directions to “ DAVID E HYDE MD” Practice Location

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