Healthcare Provider Details

I. General information

NPI: 1124018262
Provider Name (Legal Business Name): JOHN PHILLIP HURWITZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 MONTGOMERY DR
SANTA ROSA CA
95405-5214
US

IV. Provider business mailing address

122 CALISTOGA RD SUITE 197
SANTA ROSA CA
95409-3702
US

V. Phone/Fax

Practice location:
  • Phone: 707-583-1805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2OA6856
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2OA6856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: