Healthcare Provider Details

I. General information

NPI: 1497727523
Provider Name (Legal Business Name): PETER JOSEPH URDA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BISHOP LN SUITE 205
LOUISVILLE KY
40218-1922
US

IV. Provider business mailing address

1941 BISHOP LN SUITE 205
LOUISVILLE KY
40218-1922
US

V. Phone/Fax

Practice location:
  • Phone: 502-375-3242
  • Fax: 502-375-4331
Mailing address:
  • Phone: 502-375-3242
  • Fax: 502-375-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number02528
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: