Healthcare Provider Details

I. General information

NPI: 1407848567
Provider Name (Legal Business Name): JOE H JUREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 04/03/2006
Reactivation Date: 05/01/2006

III. Provider practice location address

3705 MEDICAL PKWY
AUSTIN TX
78705-1019
US

IV. Provider business mailing address

3705 MEDICAL PKWY
AUSTIN TX
78705-1030
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-6656
  • Fax: 512-458-1035
Mailing address:
  • Phone: 512-458-6656
  • Fax: 512-458-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF8530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: