Healthcare Provider Details

I. General information

NPI: 1386908762
Provider Name (Legal Business Name): ROBBIE LINN HURTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 HOGAN LN STE 2
CONWAY AR
72034-8498
US

IV. Provider business mailing address

495 HOGAN LANE #2
CONWAY AR
72034-8498
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-5850
  • Fax: 855-407-3924
Mailing address:
  • Phone: 501-327-5850
  • Fax: 855-407-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberE10645
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: