Provider Demographics
NPI:1508866302
Name:HYDE, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:HYDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 DAYTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1777
Mailing Address - Country:US
Mailing Address - Phone:937-767-7291
Mailing Address - Fax:937-767-1302
Practice Address - Street 1:888 DAYTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1777
Practice Address - Country:US
Practice Address - Phone:937-767-7291
Practice Address - Fax:937-767-1302
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35055374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0680222Medicaid
OH000000025871OtherANTHEM
OH0680222Medicaid
OH0639381Medicare PIN