Provider Demographics
NPI:1073509519
Name:HYATT, ANDREW PHILLIP (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILLIP
Last Name:HYATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N 170 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-5527
Mailing Address - Country:US
Mailing Address - Phone:801-615-5530
Mailing Address - Fax:
Practice Address - Street 1:SA-1 RM L201
Practice Address - Street 2:2401 E STREET NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20520-0001
Practice Address - Country:US
Practice Address - Phone:801-615-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150162Medicaid
ORG50710Medicare UPIN
OR150162Medicaid