Healthcare Provider Details

I. General information

NPI: 1255362489
Provider Name (Legal Business Name): WILLIAM CHARLES HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

PO BOX 660580
ARCADIA CA
91066-0580
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3200
  • Fax: 805-739-3064
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG24802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: