Healthcare Provider Details

I. General information

NPI: 1194758482
Provider Name (Legal Business Name): WAYNE ALAN HURST DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E WHITESTONE BLVD SUITE 226
CEDAR PARK TX
78613-9015
US

IV. Provider business mailing address

601 E WHITESTONE BLVD SUITE 226
CEDAR PARK TX
78613-9015
US

V. Phone/Fax

Practice location:
  • Phone: 512-259-3338
  • Fax: 512-528-1472
Mailing address:
  • Phone: 512-259-3338
  • Fax: 512-528-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1180
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: