Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 681 | NM |
Y | 103T00000X | Psychologist | 681 | NM |
NPI | 1013241140 |
---|---|
Provider Name | Dr. Bryan Lance Hurt |
First Address | Albuquerque, NM 87107-4786 |
Second Address | Albuquerque, NM 87107-4786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 22/09/2009 |