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General NPI Number Information
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NPI Number | 1821362088
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Entity Type | Individual
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Provider Name | MATTHEW WARREN HURLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 600 BLUES LAKE PKWY
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City | ROLLA
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State | MO
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Zip | 65401-8022
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Country | US
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Telephone | 573-364-8822
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Fax | 573-341-5969
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Provider Business Mailing Address
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Address Line | 600 BLUES LAKE PKWY
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City | ROLLA
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State | MO
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Zip | 65401-8022
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Country | US
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Telephone | 573-364-8822
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Fax | 573-341-5969
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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 | 036.128703
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2012012827
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License Number State | MO
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