Healthcare Provider Details

I. General information

NPI: 1508077199
Provider Name (Legal Business Name): BRENT J HURD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 VETERANS DRIVE SUITE 205
FLORENCE AL
35630
US

IV. Provider business mailing address

P.O. BOX 10005
FLORENCE AL
35631-2005
US

V. Phone/Fax

Practice location:
  • Phone: 256-767-0081
  • Fax: 256-767-3077
Mailing address:
  • Phone: 256-767-0081
  • Fax: 256-767-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO.1290
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34.009142
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS014474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: