Provider Demographics
NPI:1285717199
Name:WAYNE A. HURST, DPM, PA
Entity type:Organization
Organization Name:WAYNE A. HURST, DPM, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-259-3338
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:78613-9022
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:78613-9022
Practice Address - Country:US
Practice Address - Phone:512-259-3338
Practice Address - Fax:512-528-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178090001Medicaid
TX0078RDOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX178090001Medicaid
TX5608850001Medicare NSC
TX0078RDOtherBLUE CROSS BLUE SHIELD OF TEXAS