Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | IL | |
N | 207Q00000X | Family Doctor | IL |
NPI | 1003805136 |
---|---|
Provider Name | Dr. Martin J Hurd |
First Address | Peoria, IL 61615-9541 |
Second Address | Peoria, IL 61615-9541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E82082 | (02) |