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General NPI Number Information
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NPI Number | 1366627788
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Entity Type | Organization
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Legal Business Name | JOHN PHILLIP HURWITZ MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 3751 MONTGOMERY DR
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City | SANTA ROSA
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State | CA
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Zip | 95405-5214
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Country | US
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Telephone | 707-583-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 122 CALISTOGA RD SUITE 197
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City | SANTA ROSA
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State | CA
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Zip | 95409-3702
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN HURWITZ
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Credential | D.O.
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Telephone | 707-583-1805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2OA6856
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License Number State | CA
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