Individual
DR. DENNIS M HURTADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3777 NM HWY 528 NE, RIO RANCHO, NM 87144-7650
(505) 404-2590
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
24082
AL
207Q00000X
Family Medicine Physician
268199-1
NY
207Q00000X
Family Medicine Physician
L6070
TX
207Q00000X
Family Medicine Physician
Primary
MD2013-0983
NM
207Q00000X
Family Medicine Physician
ME105326
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24082
STATE LICENSE
AL
01
—
268199-1
STATE LICENSE
NY
01
—
E869
GROUP MDCR
—
01
—
L6070
ALLOPATHIC PHYSICIAN LIC
TX
01
—
MD2013-0983
STATE LICENSE
NM
01
—
ME105326
STATE LICENSE
FL
Enumeration date
08/05/2006
Last updated
07/25/2016
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