Provider Demographics
NPI:1063498343
Name:HYDE, GREGORY EDMUND (MD, PHD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:EDMUND
Last Name:HYDE
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-4111
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:110 E 13TH ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-2126
Practice Address - Country:US
Practice Address - Phone:765-932-7063
Practice Address - Fax:765-932-7065
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0115207Y00000X, 207YS0012X, 207YX0602X
IN01082170A207YS0012X, 207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182063102Medicaid
P00234692OtherRAILROAD MEDICARE
E53771Medicare UPIN
TX182063102Medicaid