Healthcare Provider Details

I. General information

NPI: 1972218196
Provider Name (Legal Business Name): DAVID LYNN HURTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N OKLAHOMA AVE
OKLAHOMA CITY OK
73105-2724
US

IV. Provider business mailing address

1011 DEAN PL
OKLAHOMA CITY OK
73117-1051
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-8686
  • Fax: 405-528-8692
Mailing address:
  • Phone: 405-613-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: