Provider Demographics
NPI:1255511788
Name:HYDE, NICHOLAS HUGHES (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:HUGHES
Last Name:HYDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:675 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE B214
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3860
Mailing Address - Country:US
Mailing Address - Phone:925-937-8346
Mailing Address - Fax:
Practice Address - Street 1:675 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE B214
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3860
Practice Address - Country:US
Practice Address - Phone:925-937-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062714202K00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG062714OtherMEDICAL LICENSE