Provider Demographics
NPI:1184648784
Name:HURDLE, JERALD E (DO)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:E
Last Name:HURDLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RAILROAD SQ
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6139
Mailing Address - Country:US
Mailing Address - Phone:207-877-9562
Mailing Address - Fax:207-877-9560
Practice Address - Street 1:13 RAILROAD SQ
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6139
Practice Address - Country:US
Practice Address - Phone:207-877-9562
Practice Address - Fax:207-877-9560
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-8598207Q00000X
ME2163208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHU4178374Medicare ID - Type UnspecifiedKETTERING MEDICARE #
OHHU4178371Medicare ID - Type UnspecifiedSPRINGDALE MEDICARE #
OHHU4178372Medicare ID - Type UnspecifiedMILFORD MEDICARE #
OHHU4178376Medicare ID - Type UnspecifiedCOLERAIN MEDICARE #
OHI49754Medicare UPIN
OHHU4178375Medicare ID - Type UnspecifiedDAYTON MEDICARE #
OHHU4178373Medicare ID - Type UnspecifiedMIDDLETOWN MEDICARE #
OHHU4178377Medicare ID - Type UnspecifiedFAIRBORN MEDICARE #