Healthcare Provider Details

I. General information

NPI: 1902195662
Provider Name (Legal Business Name): BRUCE V HURLEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 BELLE CHASSE HWY. B-2
GRETNA LA
70056
US

IV. Provider business mailing address

2600 BELLE CHASSE HWY. B-2
GRETNA LA
70056
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-2273
  • Fax: 504-349-6160
Mailing address:
  • Phone: 504-349-2273
  • Fax: 504-349-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number206299
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number206299
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: