Provider Demographics
NPI:1578677662
Name:HURLBUTT, RAYMOND C (DPM)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:HURLBUTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5711 E 71ST ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6628
Mailing Address - Country:US
Mailing Address - Phone:918-477-7096
Mailing Address - Fax:918-477-9362
Practice Address - Street 1:421 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6450
Practice Address - Country:US
Practice Address - Phone:918-455-2001
Practice Address - Fax:918-455-6330
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK143213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40753Medicare UPIN