Provider Demographics
NPI:1477846970
Name:HYATT, BROOKE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ANNE
Last Name:HYATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:ANNE
Other - Last Name:BOGART HYATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3529207L00000X
TXBP1-0040863207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346816701Medicaid
TX8FC510OtherBCBS TX
TX346816701Medicaid