Healthcare Provider Details

I. General information

NPI: 1811998651
Provider Name (Legal Business Name): JOEL H HURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11675 JOLLYVILLE RD STE 207
AUSTIN TX
78759-4105
US

IV. Provider business mailing address

11675 JOLLYVILLE RD STE 207
AUSTIN TX
78759-4105
US

V. Phone/Fax

Practice location:
  • Phone: 512-856-1000
  • Fax: 512-856-4040
Mailing address:
  • Phone: 512-856-1000
  • Fax: 512-856-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberL8378
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberL8378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: