Provider Demographics
NPI:1881626091
Name:HYATT, JOHN ROBERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:HYATT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4064
Mailing Address - Country:US
Mailing Address - Phone:214-801-3751
Mailing Address - Fax:
Practice Address - Street 1:3116 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4064
Practice Address - Country:US
Practice Address - Phone:214-801-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6856207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87197SOtherBCBS
TX1026320-01Medicaid
TX1026320-03Medicaid
TX1026320-03Medicaid
TX8B9902Medicare PIN
TXF24713Medicare UPIN
TX100014122Medicare PIN