Healthcare Provider Details

I. General information

NPI: 1578834578
Provider Name (Legal Business Name): DAVID B. HURST M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-1511
  • Fax:
Mailing address:
  • Phone: 850-747-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number54431
License Number StateFL

VIII. Authorized Official

Name: DAVID B. HURST
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-763-0036