Healthcare Provider Details

I. General information

NPI: 1023420825
Provider Name (Legal Business Name): DANIEL HURTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 07/02/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W D. L. INGRAM AVENUE BLDG 1408
CANNON AFB NM
88103
US

IV. Provider business mailing address

224 W D. L. INGRAM AVENUE BLDG 1408
CANNON AFB NM
88103
US

V. Phone/Fax

Practice location:
  • Phone: 575-904-3961
  • Fax:
Mailing address:
  • Phone: 575-904-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28973
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: