Individual
DR. BRUCE RONALD HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
658 E MAIN ST, CENTREVILLE, MI 49032
(269) 467-3228
(269) 467-3500
Mailing address
658 E MAIN ST, CENTREVILLE, MI 49032
(269) 467-3228
(269) 467-3500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301073551
MI
208D00000X
General Practice Physician
G69423
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301073551
MEDICAL LICENSE
MI
01
—
G69423
MEDICAL LICENSE
CA
Enumeration date
08/15/2008
Last updated
02/02/2017
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