Healthcare Provider Details

I. General information

NPI: 1316057748
Provider Name (Legal Business Name): MARY E HURLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8144 WALNUT HILL LN STE 1300
DALLAS TX
75231-4365
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 214-420-7070
  • Fax: 214-420-7380
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberK5472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: