Healthcare Provider Details

I. General information

NPI: 1801879986
Provider Name (Legal Business Name): DAVID L HURLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E STATE ROAD 205
COLUMBIA CITY IN
46725-9492
US

IV. Provider business mailing address

608 UNION CHAPEL RD
FORT WAYNE IN
46845-9357
US

V. Phone/Fax

Practice location:
  • Phone: 260-248-9411
  • Fax: 260-248-9135
Mailing address:
  • Phone: 260-482-5091
  • Fax: 260-482-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01031922
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: