Provider Demographics
NPI:1225020191
Name:HURTY, ALAN WAYNE II (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WAYNE
Last Name:HURTY
Suffix:II
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 1006
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-1006
Mailing Address - Country:US
Mailing Address - Phone:503-472-0101
Mailing Address - Fax:503-472-6363
Practice Address - Street 1:2700 SE STRATUS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6255
Practice Address - Country:US
Practice Address - Phone:503-472-0101
Practice Address - Fax:503-472-6363
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18801207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR069000Medicaid
ORR140973Medicare PIN
OR069000Medicaid