Provider Demographics
NPI:1720014756
Name:HURST, EDWARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:HURST
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 1:2380 S GOLIAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6504
Mailing Address - Country:US
Mailing Address - Phone:972-771-2020
Mailing Address - Fax:972-722-4858
Practice Address - Street 1:2380 S GOLIAD ST STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6504
Practice Address - Country:US
Practice Address - Phone:972-771-2020
Practice Address - Fax:972-722-4858
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9603207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115049201Medicaid
TX80030NMedicare PIN
TXB23661Medicare UPIN