Healthcare Provider Details

I. General information

NPI: 1225020191
Provider Name (Legal Business Name): ALAN WAYNE HURTY II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE SUITE 303
MCMINNVILLE OR
97128-6255
US

IV. Provider business mailing address

PO BOX 1006
CARLTON OR
97111-1006
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-0101
  • Fax: 503-472-6363
Mailing address:
  • Phone: 503-472-0101
  • Fax: 503-472-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD18801
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: