Healthcare Provider Details

I. General information

NPI: 1659723427
Provider Name (Legal Business Name): JACOB HURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

IV. Provider business mailing address

518 AUWAI ST
KAILUA HI
96734-2430
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-2627
  • Fax:
Mailing address:
  • Phone: 843-214-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD-21-1084
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20142
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: