Provider Demographics
NPI:1316108764
Name:HURST, GLENN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:EDWARD
Last Name:HURST
Suffix:
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 306
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51553-0306
Mailing Address - Country:US
Mailing Address - Phone:712-407-2086
Mailing Address - Fax:712-407-2087
Practice Address - Street 1:201 RIDGE ST STE 201
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-322-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5360OtherNE STATE LISCENSE NUMBER
IA38242OtherIOWA BOARD OF MEDICINE
IA38242OtherIOWA BOARD OF MEDICINE