Healthcare Provider Details

I. General information

NPI: 1750885893
Provider Name (Legal Business Name): TRAVIS JAMES URBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST
SAN FRANCISCO CA
94114-1010
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5555
  • Fax: 415-558-7035
Mailing address:
  • Phone: 415-600-5555
  • Fax: 415-558-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA165320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: