Basic Information
Provider Information
NPI: 1003011933
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HURLEY
FirstName: PATRICK
MiddleName: T.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19020 33RD AVE W
Address2: SUITE 210
City: LYNNWOOD
State: WA
PostalCode: 980364748
CountryCode: US
TelephoneNumber: 4255631500
FaxNumber: 4255631374
Practice Location
Address1: 19020 33RD AVE W
Address2: SUITE 210
City: LYNNWOOD
State: WA
PostalCode: 980364748
CountryCode: US
TelephoneNumber: 4255631500
FaxNumber: 4255631501
Other Information
ProviderEnumerationDate: 06/20/2007
LastUpdateDate: 04/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XMD00049440WAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X23852WVN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
108930205WA MEDICAID


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