Provider Demographics
NPI:1073603403
Name:HURT, CHRISTIE J (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:J
Last Name:HURT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:550 S HUDSON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2362
Practice Address - Country:US
Practice Address - Phone:417-678-5176
Practice Address - Fax:417-678-0675
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2008-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005011137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207365602Medicaid
MOI13715Medicare UPIN
MO931973230Medicare PIN