Provider Demographics
NPI:1902195662
Name:HURLEY, BRUCE V JR (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:V
Last Name:HURLEY
Suffix:JR
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 1:2600 BELLE CHASSE HWY.
Mailing Address - Street 2:B-2
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-349-2273
Mailing Address - Fax:504-349-6160
Practice Address - Street 1:2600 BELLE CHASSE HWY.
Practice Address - Street 2:B-2
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-349-2273
Practice Address - Fax:504-349-6160
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA206299207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine