Healthcare Provider Details

I. General information

NPI: 1295077055
Provider Name (Legal Business Name): PAUL HURD II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 02/06/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 NORTH BROOKE PLAZA DR STE 207
NAPLES FL
34119
US

IV. Provider business mailing address

2338 IMMOKALEE RD STE 203
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 239-919-4342
  • Fax:
Mailing address:
  • Phone: 239-919-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME139264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: