Healthcare Provider Details

I. General information

NPI: 1881611853
Provider Name (Legal Business Name): M YADIRA HURLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M YADIRA ROTHSCHILD

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD FL 3
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S SPRING AVE FL 3
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-3400
  • Fax: 314-977-7613
Mailing address:
  • Phone: 314-977-1771
  • Fax: 314-977-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number115354
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number115354
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: