Healthcare Provider Details

I. General information

NPI: 1881695559
Provider Name (Legal Business Name): WALTER GREAR HURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W LBJ FWY # 330
IRVING TX
75063-3718
US

IV. Provider business mailing address

400 W LBJ FWY # 330
IRVING TX
75063-3718
US

V. Phone/Fax

Practice location:
  • Phone: 972-556-2885
  • Fax: 972-506-8733
Mailing address:
  • Phone: 972-556-2885
  • Fax: 972-506-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberL6950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: