Healthcare Provider Details

I. General information

NPI: 1326296294
Provider Name (Legal Business Name): DAVID A HURLEY RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 CANDY PARK RD SUITE 7101-C
PEMBROKE NC
28372-9129
US

IV. Provider business mailing address

4443 WACCAMAW SHORES RD
LAKE WACCAMAW NC
28450-2401
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-0470
  • Fax:
Mailing address:
  • Phone: 910-522-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number406071
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: