Healthcare Provider Details

I. General information

NPI: 1457321622
Provider Name (Legal Business Name): MICHAEL E HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 K-V ROAD
VICTORIA VA
23974
US

IV. Provider business mailing address

PO BOX 70
VICTORIA VA
23974-0070
US

V. Phone/Fax

Practice location:
  • Phone: 434-696-2165
  • Fax: 434-696-1557
Mailing address:
  • Phone: 434-696-2165
  • Fax: 434-696-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101048683
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: