Healthcare Provider Details

I. General information

NPI: 1114217593
Provider Name (Legal Business Name): ANDREW WAYNE HURD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4032 MCDERMOTT RD STE 100
PLANO TX
75024-7739
US

IV. Provider business mailing address

751 RIDGECROSS RD
PROSPER TX
75078-7955
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-9000
  • Fax: 972-769-0035
Mailing address:
  • Phone: 205-934-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberR5869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: