Provider Demographics
NPI:1982667986
Name:HYATT, ANDREW B (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:HYATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4553
Mailing Address - Country:US
Mailing Address - Phone:573-381-5050
Mailing Address - Fax:573-519-6050
Practice Address - Street 1:1854 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4553
Practice Address - Country:US
Practice Address - Phone:573-381-5050
Practice Address - Fax:573-519-6050
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012804207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO962601701OtherMEDICARE GROUP PIN (LA)
MO962602300OtherMEDICARE GROUP PIN (BG)
MO204905905Medicaid
MOI42182Medicare UPIN