Provider Demographics
NPI:1447414776
Name:JURDI, ADHAM (MD)
Entity Type:Individual
Prefix:
First Name:ADHAM
Middle Name:
Last Name:JURDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 BURNET RD. BLDG 7. STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:125-055-5500
Mailing Address - Fax:
Practice Address - Street 1:900 E 30TH ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3378
Practice Address - Country:US
Practice Address - Phone:512-505-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276568207R00000X, 207RX0202X
TXS2607207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03971982Medicaid
NYJ400184876Medicare PIN