Healthcare Provider Details

I. General information

NPI: 1609845262
Provider Name (Legal Business Name): MARK A. HURD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W RECTOR ST # MS 54-2
SAN ANTONIO TX
78216-5718
US

IV. Provider business mailing address

PO BOX 87
SAN ANTONIO TX
78291-0087
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-0800
  • Fax: 210-358-0850
Mailing address:
  • Phone: 210-358-9174
  • Fax: 210-358-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ8598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: