Basic Information
| Provider Information | |||||||||
| NPI: | 1437389301 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURST | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5770 S 250 E STE 235 | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841076191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013145115 | ||||||||
| FaxNumber: | 8013145112 | ||||||||
| Practice Location | |||||||||
| Address1: | 5770 S 250 E STE 235 | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841076191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013145115 | ||||||||
| FaxNumber: | 8013145112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2009 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT194532 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208100000X | 53356 | MN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 105013 | MN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 8687701-1205 | UT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | ENROLLED | 05 | IA | MEDICAID | P00886907 | 01 | MN | RAILROAD MEDICARE | OTHER | ENROLLED | 05 | MN | MEDICAID |