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General NPI Number Information
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NPI Number | 1316108764
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Entity Type | Individual
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Provider Name | GLENN EDWARD HURST M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 201 RIDGE ST STE 201
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-322-5899
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | MINDEN
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State | IA
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Zip | 51553-0306
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Country | US
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Telephone | 712-407-2086
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Fax | 712-407-2087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5360
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License Number State | NE
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