Healthcare Provider Details

I. General information

NPI: 1902884786
Provider Name (Legal Business Name): GORDON B URBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 53RD AVE
BETTENDORF IA
52722-6279
US

IV. Provider business mailing address

2140 53RD AVE
BETTENDORF IA
52722-6279
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-5700
  • Fax:
Mailing address:
  • Phone: 563-421-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28322
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: