Healthcare Provider Details

I. General information

NPI: 1669555496
Provider Name (Legal Business Name): UROLOGY SPECIALISTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 N 3RD STREET SUITE 204
PHOENIX AZ
85020
US

IV. Provider business mailing address

9327 N 3RD STREET SUITE 204
PHOENIX AZ
85020
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-9679
  • Fax: 602-944-8471
Mailing address:
  • Phone: 602-944-9679
  • Fax: 602-944-8471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number7498
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0292130001
License Number StateAZ

VIII. Authorized Official

Name: DR. RAYMOND A HURM
Title or Position: OWNER
Credential: M.D.
Phone: 602-944-9679