Healthcare Provider Details

I. General information

NPI: 1306336011
Provider Name (Legal Business Name): JINWOO HUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 VETERANS MEMORIAL PKWY STE C
TUSCALOOSA AL
35404-4792
US

IV. Provider business mailing address

1718 VETERANS MEMORIAL PKWY STE A
TUSCALOOSA AL
35404-4792
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-4645
  • Fax: 855-855-2792
Mailing address:
  • Phone: 205-507-1100
  • Fax: 205-533-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: