Healthcare Provider Details

I. General information

NPI: 1356443956
Provider Name (Legal Business Name): ROBERT LYNN URATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 HOSPITAL DR
JUNEAU AK
99801-7808
US

IV. Provider business mailing address

3220 HOSPITAL DR
JUNEAU AK
99801-7808
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-2434
  • Fax: 907-586-2446
Mailing address:
  • Phone: 907-586-2434
  • Fax: 907-586-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3001
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: