Healthcare Provider Details

I. General information

NPI: 1548412422
Provider Name (Legal Business Name): GABRIEL DAVID HURST C.P.O., L.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10,000 BAY PINES BLVD. PROSTHETICS DEPT.
BAY PINES FL
33744
US

IV. Provider business mailing address

10,000 BAY PINES BLVD. PROSTHETICS DEPT.
BAY PINES FL
33744
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax: 727-398-9538
Mailing address:
  • Phone: 727-398-6661
  • Fax: 727-398-9538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberPOR127
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPOR127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: