Healthcare Provider Details

I. General information

NPI: 1982785416
Provider Name (Legal Business Name): DANIEL J. HURLEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 N CROATAN HWY
KITTY HAWK NC
27949-3990
US

IV. Provider business mailing address

5200 NORTH CROATAN HIGHWAY
KITTY HAWK NC
27949
US

V. Phone/Fax

Practice location:
  • Phone: 252-261-4187
  • Fax: 252-261-1922
Mailing address:
  • Phone: 252-261-4187
  • Fax: 252-261-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25507
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: