Provider Demographics
NPI:1396156394
Name:HYATT, MATTHEW BRETT (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRETT
Last Name:HYATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EDENBERG BND
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-2302
Mailing Address - Country:US
Mailing Address - Phone:601-319-6015
Mailing Address - Fax:
Practice Address - Street 1:1151 N STATE ST STE 404
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2457
Practice Address - Country:US
Practice Address - Phone:601-292-4261
Practice Address - Fax:601-292-4262
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-060902085R0202X, 2085R0204X
MS557692085R0202X
390200000X
MS274462085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program