Healthcare Provider Details

I. General information

NPI: 1295265304
Provider Name (Legal Business Name): TIMOTHY JOEL HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-1956
  • Fax:
Mailing address:
  • Phone: 319-356-1956
  • Fax: 319-356-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD-48977
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: