Provider Demographics
NPI:1619968815
Name:HURD, MARVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:M
Last Name:HURD
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 1:809 46TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2911
Mailing Address - Country:US
Mailing Address - Phone:515-224-9199
Mailing Address - Fax:515-224-9599
Practice Address - Street 1:809 46TH ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2911
Practice Address - Country:US
Practice Address - Phone:515-224-9199
Practice Address - Fax:515-224-9599
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19057208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA21036Medicare ID - Type Unspecified
A02334Medicare UPIN