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Individual

DR. GLEN D HURLSTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1020 W FERTITTA BLVD, LEESVILLE, LA 71446-4649
(337) 475-9927
(337) 475-9989
Mailing address
PO BOX 54346, NEW ORLEANS, LA 70154-4346
(337) 475-9927
(337) 475-9989

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
022284
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1676276
LA
Enumeration date
11/30/2006
Last updated
07/09/2007
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