Provider Demographics
NPI:1821018854
Name:HYDE, MARK A (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:HYDE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:284 LEWIS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5748
Mailing Address - Country:US
Mailing Address - Phone:801-581-2955
Mailing Address - Fax:801-585-3903
Practice Address - Street 1:HELIX BLDG 5050
Practice Address - Street 2:30 N MARIO CAPECCHI DR
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112
Practice Address - Country:US
Practice Address - Phone:801-581-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6305915-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ57017Medicare UPIN