MEDICARE: JAMES HURSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	23218	AL
2	208D00000X	General Practice Physician	23218	AL

General Provider Information

NPI Number	:	1306928999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES HURSON

Provider Business Mailing Address
First Line	:	25405 PERDIDO BEACH BLVD STE 18
Second Line	:
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-3133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25405 PERDIDO BEACH BLVD STE 18
Second Line	:
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-3133
Country	:	US
Telephone Number	:	251-964-7425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	09/09/2015

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Directions to “ JAMES HURSON ” Practice Location

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