Basic Information
| Provider Information | |||||||||
| NPI: | 1588012298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUROVCIK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 TWINING ST BLDG 760 | ||||||||
| Address2: | |||||||||
| City: | MAXWELL AFB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361126027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349533368 | ||||||||
| FaxNumber: | 3349538607 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 TWINING ST BLDG 760 | ||||||||
| Address2: | |||||||||
| City: | MAXWELL AFB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361126027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349533368 | ||||||||
| FaxNumber: | 3349538607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2016 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 1763 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.