Provider Demographics
NPI:1629096086
Name:HYDE, DOUGLASS Y (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLASS
Middle Name:Y
Last Name:HYDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 MEDI PARK
Mailing Address - Street 2:SUITE 10
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2105
Mailing Address - Country:US
Mailing Address - Phone:806-356-2310
Mailing Address - Fax:806-356-2312
Practice Address - Street 1:1901 MEDI PARK
Practice Address - Street 2:SUITE 10
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2105
Practice Address - Country:US
Practice Address - Phone:806-356-2310
Practice Address - Fax:806-356-2312
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF5580207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089697901Medicaid
TX0536260001Medicare NSC
TX00TW77Medicare PIN
TX089697901Medicaid