Provider Demographics
NPI:1104830363
Name:HURT, JOHN O JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O
Last Name:HURT
Suffix:JR
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:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-1337
Mailing Address - Country:US
Mailing Address - Phone:276-236-3210
Mailing Address - Fax:276-236-3015
Practice Address - Street 1:500 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2208
Practice Address - Country:US
Practice Address - Phone:276-236-0179
Practice Address - Fax:276-238-3561
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010169082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09195Medicare UPIN