Provider Demographics
NPI:1073970505
Name:HURD, LANDON RAY
Entity Type:Individual
Prefix:MR
First Name:LANDON
Middle Name:RAY
Last Name:HURD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 DUNCAN PERRY RD APT 2023
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2977
Mailing Address - Country:US
Mailing Address - Phone:469-703-2957
Mailing Address - Fax:469-520-5665
Practice Address - Street 1:958 DUNCAN PERRY RD APT 2023
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2977
Practice Address - Country:US
Practice Address - Phone:469-703-2957
Practice Address - Fax:469-520-5665
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle