Provider Demographics
NPI:1689874836
Name:JONATHAN D HYMAN DPM A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JONATHAN D HYMAN DPM A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-666-9934
Mailing Address - Street 1:5959 WEST LOOP S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2421
Mailing Address - Country:US
Mailing Address - Phone:713-666-9934
Mailing Address - Fax:713-666-8659
Practice Address - Street 1:5959 WEST LOOP S
Practice Address - Street 2:SUITE 130
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2421
Practice Address - Country:US
Practice Address - Phone:713-666-9934
Practice Address - Fax:713-666-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0387213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX480004754OtherMEDICARE RRB
TXIDEC2526069OtherACED
TXTX9999OtherMUTUAL
TX119889702Medicaid
TXT13988OtherBLUE CROSS BLUE SHIELD
TX77096OtherTRICARE
TX119889702Medicaid
TX119889702Medicaid