Healthcare Provider Details

I. General information

NPI: 1669440947
Provider Name (Legal Business Name): ROBERT C URBAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 WATER ST
NEW PORT RICHEY FL
34652-4030
US

IV. Provider business mailing address

5425 WATER ST
NEW PORT RICHEY FL
34652-4030
US

V. Phone/Fax

Practice location:
  • Phone: 727-807-7090
  • Fax: 727-807-7076
Mailing address:
  • Phone: 727-807-7090
  • Fax: 727-807-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME63362
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberME63362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: