Healthcare Provider Details

I. General information

NPI: 1023087509
Provider Name (Legal Business Name): JOHN C HURST JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BROOKWOOD MEDICAL CTR DR SUITE 202, WMP
BIRMINGHAM AL
35209-6899
US

IV. Provider business mailing address

2006 BROOKWOOD MEDICAL CTR DR SUITE 202, WMP
BIRMINGHAM AL
35209-6899
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-2850
  • Fax: 205-877-2858
Mailing address:
  • Phone: 205-397-8850
  • Fax: 205-397-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5984
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: