Healthcare Provider Details

I. General information

NPI: 1780807396
Provider Name (Legal Business Name): WAYNE EDWARD HURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 S STEELE ST
TACOMA WA
98409-7312
US

IV. Provider business mailing address

4218 S STEELE ST
TACOMA WA
98409-7312
US

V. Phone/Fax

Practice location:
  • Phone: 253-682-4100
  • Fax: 253-472-4140
Mailing address:
  • Phone: 253-682-4100
  • Fax: 253-472-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00024515
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: