Healthcare Provider Details

I. General information

NPI: 1619985751
Provider Name (Legal Business Name): RICHARD B URBAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 NW 53RD AVE
GAINESVILLE FL
32653-4898
US

IV. Provider business mailing address

4611 NW 53RD AVE
GAINESVILLE FL
32653-4898
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-0301
  • Fax: 352-371-4635
Mailing address:
  • Phone: 352-371-0301
  • Fax: 352-371-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 20066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: