Basic Information
| Provider Information | |||||||||
| NPI: | 1376923466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYDER | ||||||||
| FirstName: | JALAL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241952 | ||||||||
| FaxNumber: | 4198240344 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 HARROUN RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241952 | ||||||||
| FaxNumber: | 4198240344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2015 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 5101025662 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 390200000X | NE | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0001X | 34.014692 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.