Healthcare Provider Details

I. General information

NPI: 1578644670
Provider Name (Legal Business Name): GREGORY DARYL URBAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 N 1ST ST
GRAND JUNCTION CO
81501-2102
US

IV. Provider business mailing address

1215 N 1ST ST
GRAND JUNCTION CO
81501-2102
US

V. Phone/Fax

Practice location:
  • Phone: 970-255-1720
  • Fax: 970-255-1745
Mailing address:
  • Phone: 970-255-1720
  • Fax: 970-255-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number29673
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: