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NPI Code Detail

MEDICARE: FRED HURST MD

MEDICARE: FRED HURST MD
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
1207Q00000XFamily Medicine PhysicianC34125CA

General Provider Information

NPI Number : 1114927720
Entity Type Code : Individual
Provider Name (Legal Business Name) : FRED HURST MD
Provider Business Mailing Address
First Line : 279 IMPERIAL HWY
Second Line : SUITE 730
City : FULLERTON
State : CA
Zip : 92835-1041
Country : US
Telephone Number : 714-449-4841
Fax Number : 714-449-4956
Provider Business Practice Location Address
First Line : 4300 ROSE DR
Second Line :
City : YORBA LINDA
State : CA
Zip : 92886-2026
Country : US
Telephone Number : 714-528-4211
Fax Number : 714-579-6868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 04/25/2013

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Directions to “ FRED HURST MD” Practice Location

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