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General NPI Number Information
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NPI Number | 1881990513
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Entity Type | Organization
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Legal Business Name | HURST OSTEOPATHIC MEDICINE, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 632 W 11TH ST SUITE 119
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City | TRACY
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State | CA
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Zip | 95376-3856
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Country | US
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Telephone | 209-832-5500
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Fax | 209-832-5505
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Provider Business Mailing Address
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Address Line | 632 W 11TH ST SUITE 119
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City | TRACY
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State | CA
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Zip | 95376-3856
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Country | US
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Telephone | 209-832-5500
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Fax | 209-832-5505
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHAEL D HURST
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Credential | D.O.
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Telephone | 209-832-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A8081
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A8081
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License Number State | CA
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