Healthcare Provider Details

I. General information

NPI: 1255399812
Provider Name (Legal Business Name): MICHAEL DEAN HURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7190 E KIERLAND BLVD UNIT 924
SCOTTSDALE AZ
85254-0081
US

IV. Provider business mailing address

7190 E KIERLAND BLVD # 294
SCOTTSDALE AZ
85254-2657
US

V. Phone/Fax

Practice location:
  • Phone: 515-491-7755
  • Fax:
Mailing address:
  • Phone: 515-491-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number28371
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number36315
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: