Healthcare Provider Details

I. General information

NPI: 1306041975
Provider Name (Legal Business Name): DEJAN JURIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4000
  • Fax:
Mailing address:
  • Phone: 617-724-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number247750
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: