Provider Demographics
NPI:1558048470
Name:HYATT, GAROLD BENJAMIN
Entity Type:Individual
Prefix:
First Name:GAROLD
Middle Name:BENJAMIN
Last Name:HYATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 RUTLAND DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7617
Mailing Address - Country:US
Mailing Address - Phone:701-204-8634
Mailing Address - Fax:
Practice Address - Street 1:3325 RUTLAND DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7617
Practice Address - Country:US
Practice Address - Phone:701-204-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant