Provider Demographics
NPI:1558341024
Name:HYDE, JOHNNY JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:HYDE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:MOB SOUTH, SUITE G-7
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-228-8900
Mailing Address - Fax:804-282-9460
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:MOB SOUTH, SUITE G-7
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-228-8900
Practice Address - Fax:804-282-9460
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239563174400000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010266271Medicaid
VAC06778OtherGROUP PTAN
VA10008181OtherOPTIMA
VAP00360751OtherRAILROAD MEDICARE
VAP00360751OtherRAILROAD MEDICARE
VAH92182Medicare UPIN
VA011314V63Medicare PIN
VA010137V25Medicare PIN