Healthcare Provider Details

I. General information

NPI: 1992761365
Provider Name (Legal Business Name): PHILIP K HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TAD HURST MD

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE EMERGENCY DEPARTMENT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-6986
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG66293
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036149538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: