Healthcare Provider Details

I. General information

NPI: 1093975161
Provider Name (Legal Business Name): DAVID A. HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID HURST MD

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 NW LAKE WHITNEY PL
PORT ST LUCIE FL
34986-1620
US

IV. Provider business mailing address

1700 SE HILLMOOR DR
PORT ST LUCIE FL
34952-7539
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-9600
  • Fax:
Mailing address:
  • Phone: 772-335-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME108482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: