Healthcare Provider Details

I. General information

NPI: 1538216239
Provider Name (Legal Business Name): WILLIAM C HURD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S CLAYBROOK ST STE 101
MEMPHIS TN
38104-3538
US

IV. Provider business mailing address

220 S CLAYBROOK ST STE 101
MEMPHIS TN
38104-3538
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-4844
  • Fax: 901-276-0926
Mailing address:
  • Phone: 901-276-4844
  • Fax: 901-276-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12279
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0013888
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: