Provider Demographics
NPI:1194768085
Name:HURT, GARY P (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:HURT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:P
Other - Last Name:HARTMAN-HURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5050 HAWK HILL WAY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:269-762-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54585207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10/4758310Medicaid
MI10/4669650Medicaid
MIOC96159067Medicare ID - Type UnspecifiedBRONSON
MI10/4758310Medicaid
MIM79650026Medicare ID - Type UnspecifiedLAKEVIEW
MIP08090032Medicare ID - Type UnspecifiedALLEGAN