Provider Demographics
NPI:1609577444
Name:HYMAN, THEODORE (BS)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:HYMAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:TED
Other - Middle Name:
Other - Last Name:HYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1509 SPIROS DR APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-5523
Mailing Address - Country:US
Mailing Address - Phone:918-899-9411
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-1000
Practice Address - Country:US
Practice Address - Phone:918-899-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program