Healthcare Provider Details

I. General information

NPI: 1730183492
Provider Name (Legal Business Name): KEVIN MARTIN HURLBUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARTY HURLBUT M.D.

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E MONTE PAINTER DR
FAYETTEVILLE AR
72703-4002
US

IV. Provider business mailing address

PO BOX 8638
FAYETTEVILLE AR
72703-0011
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-2207
  • Fax: 479-444-2381
Mailing address:
  • Phone: 479-444-2207
  • Fax: 479-444-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberN-8015
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: