Provider Demographics
NPI:1578603163
Name:HURT, RYAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:T
Last Name:HURT
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 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41631207R00000X
MN51495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100051600Medicaid
KY00533078OtherMEDICARE- NORTON INPATIENT SPECIALISTS
MNP00835577OtherRAILROAD MEDICARE
KY000000593140OtherANTHEM- NORTON INPATIENT SPECIALISTS
KY3690757000OtherPASSPORT ADVANTAGE- NORTON INPATIENT SPECIALISTS
IAENROLLEDMedicaid
MNENROLLEDMedicaid
KY200905520OtherMEDICAID INDIANA- NORTON INPATIENT SPECIALISTS
KY000023034LOtherHUMANA- NORTON INPATIENT SPECIALISTS
KY50022198OtherPASSPORT- NORTON INPATIENT SPECIALISTS
KY50022198OtherPASSPORT- NORTON INPATIENT SPECIALISTS
MNENROLLEDMedicaid