Healthcare Provider Details

I. General information

NPI: 1497708259
Provider Name (Legal Business Name): DENNIS M HURFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 S STATE ROUTE 157 STE 100
GLEN CARBON IL
62034-1717
US

IV. Provider business mailing address

2246 ILLINOIS STATE ROUTE 157 SUITE 100
GLEN CARBON IL
62034
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-9251
  • Fax: 618-288-6900
Mailing address:
  • Phone: 618-288-9251
  • Fax: 618-288-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036097153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: