Provider Demographics
NPI:1952377236
Name:HURSH, TIMOTHY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:HURSH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-9330
Mailing Address - Country:US
Mailing Address - Phone:307-387-9850
Mailing Address - Fax:307-387-9890
Practice Address - Street 1:469 HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-9330
Practice Address - Country:US
Practice Address - Phone:307-387-9850
Practice Address - Fax:307-387-9890
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16947207PE0005X
TXN1684207PE0005X
WYTL86312083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY18323AOtherWY LICENSE
TX2033284-01Medicaid