MEDICARE: MR. LANDON RAY HURD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1073970505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LANDON RAY HURD

Provider Business Mailing Address
First Line	:	958 DUNCAN PERRY RD APT 2023
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2977
Country	:	US
Telephone Number	:	469-703-2957
Fax Number	:	469-520-5665

Provider Business Practice Location Address
First Line	:	958 DUNCAN PERRY RD APT 2023
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2977
Country	:	US
Telephone Number	:	469-703-2957
Fax Number	:	469-520-5665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	01/28/2016

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