Provider Demographics
NPI:1194758482
Name:HURST, WAYNE ALAN (DPM)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALAN
Last Name:HURST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9015
Mailing Address - Country:US
Mailing Address - Phone:512-259-3338
Mailing Address - Fax:512-528-1472
Practice Address - Street 1:601 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 226
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9015
Practice Address - Country:US
Practice Address - Phone:512-259-3338
Practice Address - Fax:512-528-1472
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121568305Medicaid
TX8BD530OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX178090001OtherGROUP MEDICAID
TX480016443OtherRAILROAD MEDICARE
TX00618ZOtherGROUP MEDICARE
TX5608850001OtherDMERC-MEDICARE
TX8F1329Medicare ID - Type Unspecified
TX00618ZOtherGROUP MEDICARE