Provider Demographics
NPI:1962594879
Name:HYDE, MARC PAUL (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:PAUL
Last Name:HYDE
Suffix:
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 1:2637 E SPRING HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4036
Mailing Address - Country:US
Mailing Address - Phone:801-910-1905
Mailing Address - Fax:
Practice Address - Street 1:2637 E SPRING HOLLOW DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-4036
Practice Address - Country:US
Practice Address - Phone:801-910-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT355644-1205207P00000X
NE26154207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BH9833686OtherDEA NUMBER