Provider Demographics
NPI:1558013045
Name:HYDE, MATTHEW ROBERT (CSFA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:HYDE
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N ROBBINS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4566
Mailing Address - Country:US
Mailing Address - Phone:208-489-4279
Mailing Address - Fax:
Practice Address - Street 1:600 N ROBBINS RD STE 401
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4566
Practice Address - Country:US
Practice Address - Phone:208-489-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Single Specialty