Provider Demographics
NPI:1528556297
Name:HURTT, WILLIAM CARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CARL
Last Name:HURTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 ASHFORD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2005
Mailing Address - Country:US
Mailing Address - Phone:559-577-4490
Mailing Address - Fax:
Practice Address - Street 1:700 W OLIVE AVE
Practice Address - Street 2:STE C
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2435
Practice Address - Country:US
Practice Address - Phone:209-384-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5738213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program