Healthcare Provider Details

I. General information

NPI: 1578299160
Provider Name (Legal Business Name): DEREK HURD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 S US HIGHWAY 1 STE 201
JUPITER FL
33477-1125
US

IV. Provider business mailing address

4300 S US HIGHWAY 1 STE 201
JUPITER FL
33477-1125
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-7491
  • Fax:
Mailing address:
  • Phone: 561-247-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: