Provider Demographics
NPI:1366494304
Name:HYDE, KARL GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:GRANT
Last Name:HYDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3024
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0298
Mailing Address - Country:US
Mailing Address - Phone:518-561-1603
Mailing Address - Fax:518-561-0179
Practice Address - Street 1:1445 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4248
Practice Address - Country:US
Practice Address - Phone:503-566-3507
Practice Address - Fax:503-581-4405
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25679207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213437Medicaid
WA8424087Medicaid
ORP00303137OtherRR MEDICARE
WA8424087Medicaid
OR213437Medicaid