Provider Demographics
NPI:1275601544
Name:HYDE, PHILIP CARLTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CARLTON
Last Name:HYDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4401
Mailing Address - Country:US
Mailing Address - Phone:405-842-4435
Mailing Address - Fax:405-842-2846
Practice Address - Street 1:1117 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4401
Practice Address - Country:US
Practice Address - Phone:405-842-4435
Practice Address - Fax:405-842-2846
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100837830AMedicaid
OK100837830AMedicaid