Healthcare Provider Details

I. General information

NPI: 1821209149
Provider Name (Legal Business Name): DANIEL E HURST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

540 NELSON AVE
MORTON IL
61550-1926
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-7257
  • Fax:
Mailing address:
  • Phone: 309-740-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: