Provider Demographics
NPI:1326296294
Name:HURLEY, DAVID A (RT(R))
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:HURLEY
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4443 WACCAMAW SHORES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450-2401
Mailing Address - Country:US
Mailing Address - Phone:910-522-0470
Mailing Address - Fax:
Practice Address - Street 1:812 CANDY PARK RD
Practice Address - Street 2:SUITE 7101-C
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9129
Practice Address - Country:US
Practice Address - Phone:910-522-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471C3402X
NC4060712471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography