Provider Demographics
NPI:1801879986
Name:HURLEY, DAVID L (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:HURLEY
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 1:608 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9357
Mailing Address - Country:US
Mailing Address - Phone:260-482-5091
Mailing Address - Fax:260-482-4442
Practice Address - Street 1:1260 E STATE ROAD 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-9492
Practice Address - Country:US
Practice Address - Phone:260-248-9411
Practice Address - Fax:260-248-9135
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031922207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517057Medicaid
IN000000082543OtherANTHEM
MI104874516Medicaid
000000010122OtherMPLAN
IN100263130Medicaid
IN100263130Medicaid
000000010122OtherMPLAN
IN047840GGGGMedicare ID - Type Unspecified