Provider Demographics
NPI:1275583635
Name:HURST, ELTON L (MD)
Entity Type:Individual
Prefix:
First Name:ELTON
Middle Name:L
Last Name:HURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3504 VANN ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-655-0585
Mailing Address - Fax:205-655-0586
Practice Address - Street 1:3504 VANN ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-655-0585
Practice Address - Fax:205-655-0586
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL000132782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55894Medicare UPIN