Provider Demographics
NPI:1356343503
Name:HURM, RAYMOND A (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:HURM
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:9327 N 3RD ST #204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2473
Practice Address - Country:US
Practice Address - Phone:602-944-9679
Practice Address - Fax:602-944-8471
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7498208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218314Medicaid
AZP01165312OtherRAILROAD MCR
AZ1803508OtherCIGNA
AZ4022121OtherAETNA
AZ787313OtherWELLCARE MEDICARE ADVANTAGE
AZZWCLGS02Medicare PIN
AZ4022121OtherAETNA
AZ1803508OtherCIGNA