Provider Demographics
NPI:1699750836
Name:HURLBUT, STEPHEN C (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:HURLBUT
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 1:1604 HOSPITAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6930
Mailing Address - Country:US
Mailing Address - Phone:817-848-4485
Mailing Address - Fax:817-848-4490
Practice Address - Street 1:1604 HOSPITAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6930
Practice Address - Country:US
Practice Address - Phone:817-848-4485
Practice Address - Fax:817-848-4490
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ79952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104029704Medicaid
TXF01828Medicare UPIN
TX8L7747Medicare PIN