Healthcare Provider Details

I. General information

NPI: 1356392815
Provider Name (Legal Business Name): JAMES MARK HURD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MONTGOMERY DR
SANTA ROSA CA
95405-4801
US

IV. Provider business mailing address

PO BOX 7793
SAN FRANCISCO CA
94120-7793
US

V. Phone/Fax

Practice location:
  • Phone: 707-546-3210
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA43826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: