Provider Demographics
NPI:1104009463
Name:HYDEN, LORI GAYE (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:GAYE
Last Name:HYDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:GAYE
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:201 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4227
Mailing Address - Country:US
Mailing Address - Phone:918-341-5200
Mailing Address - Fax:918-341-5872
Practice Address - Street 1:201 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4227
Practice Address - Country:US
Practice Address - Phone:918-341-5200
Practice Address - Fax:918-341-5872
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200297190AMedicaid
OK200297190AMedicaid