Provider Demographics
NPI:1114960341
Name:HURWITZ, BEVERLY (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:HURWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017-0463
Mailing Address - Country:US
Mailing Address - Phone:801-485-4994
Mailing Address - Fax:801-485-9282
Practice Address - Street 1:1245 EAST BRICKYARD RD
Practice Address - Street 2:STE 330
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-485-4994
Practice Address - Fax:801-485-9282
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT182129-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE15672Medicare UPIN