Healthcare Provider Details

I. General information

NPI: 1891712899
Provider Name (Legal Business Name): JASON WAYNE HURT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD SUITE 3
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

PO BOX 8850
FAYETTEVILLE AR
72703-0015
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-4433
  • Fax: 479-521-0444
Mailing address:
  • Phone: 479-521-4433
  • Fax: 479-521-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberT2006-068
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: