Healthcare Provider Details

I. General information

NPI: 1841785193
Provider Name (Legal Business Name): MICHAEL GLENN HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

210 CIRCLE ST APT 1
SAN ANTONIO TX
78209-5358
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-2032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL52669
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: