Provider Demographics
NPI:1477655579
Name:HURLEY, SEAN D (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:D
Last Name:HURLEY
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-489-4040
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:9631 N NEVADA ST
Practice Address - Street 2:STE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-489-4040
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110140054OtherTRAV MEDICARE
109428OtherL I
WA1477655579OtherNPI
WA1098995Medicaid
G30911Medicare UPIN
WA110140054OtherTRAV MEDICARE