Healthcare Provider Details

I. General information

NPI: 1194768085
Provider Name (Legal Business Name): GARY P. HURT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GARY P. HARTMAN-HURT M.D.

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

5050 HAWK HILL WAY
MARYVILLE TN
37801-3554
US

V. Phone/Fax

Practice location:
  • Phone: 269-762-0048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number54585
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: