Provider Demographics
NPI:1437389301
Name:HURST, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:HURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 S 250 E STE 235
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6191
Mailing Address - Country:US
Mailing Address - Phone:801-314-5115
Mailing Address - Fax:801-314-5112
Practice Address - Street 1:5770 S 250 E STE 235
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6191
Practice Address - Country:US
Practice Address - Phone:801-314-5115
Practice Address - Fax:801-314-5112
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194532207R00000X
MN53356208100000X
MN105013208100000X
UT8687701-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
MNP00886907OtherRAILROAD MEDICARE
MNENROLLEDMedicaid
IAENROLLEDMedicaid