Provider Demographics
NPI:1184725079
Name:HURLBURT, KATHY J (MD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:HURLBURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3220 PROVIDENCE DR STE E3-040
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4679
Mailing Address - Country:US
Mailing Address - Phone:907-278-2880
Mailing Address - Fax:907-278-2881
Practice Address - Street 1:3220 PROVIDENCE DR STE E3-040
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4679
Practice Address - Country:US
Practice Address - Phone:907-278-2880
Practice Address - Fax:907-278-2881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2283Medicaid
AKMD2283Medicaid
AKK152354Medicare PIN