Provider Demographics
NPI:1730183492
Name:HURLBUT, KEVIN MARTIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARTIN
Last Name:HURLBUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:HURLBUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8638
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0011
Mailing Address - Country:US
Mailing Address - Phone:479-444-2207
Mailing Address - Fax:479-444-2381
Practice Address - Street 1:153 E MONTE PAINTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4002
Practice Address - Country:US
Practice Address - Phone:479-444-2207
Practice Address - Fax:479-444-2381
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-8015208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR14676770802OtherGROUP NPI
AR54076Medicare PIN
AR54076Medicare ID - Type UnspecifiedPROVIDER NUMBER
ARE63398Medicare UPIN