Healthcare Provider Details

I. General information

NPI: 1285822007
Provider Name (Legal Business Name): STEFAN ALEXANDER HURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 OAK LAWN AVE UNIT 192749
DALLAS TX
75219-4688
US

IV. Provider business mailing address

2825 OAK LAWN AVE UNIT 192749
DALLAS TX
75219-4688
US

V. Phone/Fax

Practice location:
  • Phone: 844-389-5711
  • Fax: 877-880-2039
Mailing address:
  • Phone: 844-389-5711
  • Fax: 877-880-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA90564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR9371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: