Healthcare Provider Details

I. General information

NPI: 1598799314
Provider Name (Legal Business Name): JOHN GORDON HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST
GREELEY CO
80631-5154
US

IV. Provider business mailing address

PO BOX 337420
GREELEY CO
80633-0624
US

V. Phone/Fax

Practice location:
  • Phone: 970-679-9349
  • Fax:
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22264
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: