Healthcare Provider Details

I. General information

NPI: 1942236179
Provider Name (Legal Business Name): TIMOTHY J HURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 RUTLEDGE RD NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

3741 RUTLEDGE RD NE
ALBUQUERQUE NM
87109-5566
US

V. Phone/Fax

Practice location:
  • Phone: 505-798-9300
  • Fax: 505-798-0808
Mailing address:
  • Phone: 505-798-9300
  • Fax: 505-798-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number92-255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: