Basic Information
Provider Information | |||||||||
NPI: | 1053571414 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JURUS | ||||||||
FirstName: | DEREK | ||||||||
MiddleName: | T | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5 WASHINGTON PL | ||||||||
Address2: | DARTMOUTH HITCHCOCK - OB/GYN | ||||||||
City: | BEDFORD | ||||||||
State: | NH | ||||||||
PostalCode: | 031106736 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036952900 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5 WASHINGTON PL | ||||||||
Address2: | DARTMOUTH HITCHCOCK - OB/GYN | ||||||||
City: | BEDFORD | ||||||||
State: | NH | ||||||||
PostalCode: | 031106736 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036952900 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/10/2008 | ||||||||
LastUpdateDate: | 11/27/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | H0075851 | MD | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | 17171 | NH | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 119591300 | 05 | MD |   | MEDICAID | 1026016 | 05 | VT |   | MEDICAID | 3101765 | 05 | NH |   | MEDICAID |