Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME74929 | FL |
N | 207RI0011X | Interventional Cardiology | ME 74929 | FL |
NPI | 1093710790 |
---|---|
Provider Name | Dr. John Richard Hurt II |
First Address | Leesburg, FL 34748-7326 |
Second Address | Leesburg, FL 34748-7326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0108467 | (05) | OH |
01484956 | (05) | PA |
593516436003 | TRICARE (01) | |
695956 | TUFTS (01) | |
773114 | MAILHANDLERS (01) | |
7914953 | MAMSI (01) | |
92419 | BCBS FLORIDA (01) | |
E85493 | (02) | |
P00391218 | GBA RR PALMETTO (01) |