Provider Demographics
NPI:1962757989
Name:HYDE-PERSON, TALIA ANTIONETTE (DPM)
Entity type:Individual
Prefix:DR
First Name:TALIA
Middle Name:ANTIONETTE
Last Name:HYDE-PERSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10016 OFFICE CENTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1468
Mailing Address - Country:US
Mailing Address - Phone:314-720-0855
Mailing Address - Fax:314-735-4339
Practice Address - Street 1:10016 OFFICE CENTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1468
Practice Address - Country:US
Practice Address - Phone:314-720-0855
Practice Address - Fax:314-735-4339
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist