Provider Demographics
NPI:1457526402
Name:GREGORY E HYDE MD PHD PA
Entity Type:Organization
Organization Name:GREGORY E HYDE MD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:936-560-2600
Mailing Address - Street 1:1018 MOUND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4434
Mailing Address - Country:US
Mailing Address - Phone:936-560-2600
Mailing Address - Fax:936-560-4500
Practice Address - Street 1:1018 MOUND ST STE 103
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4434
Practice Address - Country:US
Practice Address - Phone:936-560-2600
Practice Address - Fax:936-560-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0115207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210776501Medicaid
DD5475OtherRAILROAD MEDICARE
TX0A3199Medicare PIN
TXE53771Medicare UPIN