Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 15965 | WV |
NPI | 1003914136 |
---|---|
Provider Name | Dr. Michael Hurst |
First Address | Morgantown, WV 26507-0897 |
Second Address | Morgantown, WV 26506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100463000 | (05) | WV |
F06544 | (02) |