Provider Demographics
NPI:1164496980
Name:HYDE, LEE SANFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:SANFORD
Last Name:HYDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22A NEW LEICESTER HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806
Mailing Address - Country:US
Mailing Address - Phone:828-252-8341
Mailing Address - Fax:828-254-2317
Practice Address - Street 1:CHEROKEE INDIAN HOSPITAL
Practice Address - Street 2:1 HOSPITAL ROAD
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30921OtherSTATE LICENSE NUMBER
NC8945182Medicaid
NC8945182Medicaid
8TA014Medicare ID - Type Unspecified