Healthcare Provider Details

I. General information

NPI: 1477655579
Provider Name (Legal Business Name): SEAN D HURLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9631 N NEVADA ST STE 300
SPOKANE WA
99218
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-4040
  • Fax: 509-227-7070
Mailing address:
  • Phone: 509-489-4040
  • Fax: 509-227-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00033629
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: