Healthcare Provider Details

I. General information

NPI: 1891866190
Provider Name (Legal Business Name): MARK A HURT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 MILLPARK DR
MARYLAND HEIGHTS MO
63043-3530
US

IV. Provider business mailing address

2326 MILLPARK DR
MARYLAND HEIGHTS MO
63043-3530
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4313
  • Fax: 314-991-4317
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number36381
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: