Healthcare Provider Details

I. General information

NPI: 1689680142
Provider Name (Legal Business Name): STEPHEN S HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 N SAN MATEO DR
SAN MATEO CA
94401-2889
US

IV. Provider business mailing address

77 N SAN MATEO DR
SAN MATEO CA
94401-2889
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-0854
  • Fax: 650-342-2198
Mailing address:
  • Phone: 650-342-0854
  • Fax: 650-342-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC29447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: