Provider Demographics
NPI:1669845772
Name:HURFORD, JEREMY MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:HURFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:OKEENE
Mailing Address - State:OK
Mailing Address - Zip Code:73763-0389
Mailing Address - Country:US
Mailing Address - Phone:580-822-4404
Mailing Address - Fax:580-822-4403
Practice Address - Street 1:124 N 6TH ST
Practice Address - Street 2:
Practice Address - City:OKEENE
Practice Address - State:OK
Practice Address - Zip Code:73763-9135
Practice Address - Country:US
Practice Address - Phone:580-833-4404
Practice Address - Fax:580-822-4403
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK471025ZL9ZOtherMEDICARE PTAN