Healthcare Provider Details

I. General information

NPI: 1023220464
Provider Name (Legal Business Name): EVA A HURST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 11/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 OFFICE COURT
FAIRVIEW HEIGHTS IL
62208
US

IV. Provider business mailing address

390 OFFICE COURT
FAIRVIEW HEIGHTS IL
62208
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7666
  • Fax: 618-233-7461
Mailing address:
  • Phone: 618-233-7666
  • Fax: 618-233-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number2007020114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: