Healthcare Provider Details

I. General information

NPI: 1538429725
Provider Name (Legal Business Name): JAMES BRANDON HURLBURT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 N STATE HIGHWAY 161 STE 100
IRVING TX
75038-2239
US

IV. Provider business mailing address

450 CYPRESS CREEK RD BLDG 5
CEDAR PARK TX
78613-4194
US

V. Phone/Fax

Practice location:
  • Phone: 469-200-3272
  • Fax:
Mailing address:
  • Phone: 512-249-1400
  • Fax: 512-249-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP8917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: