Healthcare Provider Details

I. General information

NPI: 1578677662
Provider Name (Legal Business Name): RAYMOND C HURLBUTT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W WASHINGTON ST
BROKEN ARROW OK
74012-6450
US

IV. Provider business mailing address

5711 E 71ST ST SUITE 220
TULSA OK
74136-6628
US

V. Phone/Fax

Practice location:
  • Phone: 918-455-2001
  • Fax: 918-455-6330
Mailing address:
  • Phone: 918-477-7096
  • Fax: 918-477-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number143
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: