Healthcare Provider Details

I. General information

NPI: 1649264755
Provider Name (Legal Business Name): EDWIN ROMMEL URBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: EDWIN ROMMEL SOLDAD URBI MD

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 JACKSON STREET EXT
ALEXANDRIA LA
71303-2752
US

IV. Provider business mailing address

6221 GRAND OAK DR
ALEXANDRIA LA
71301-2334
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0035
  • Fax: 318-443-0220
Mailing address:
  • Phone: 318-473-1909
  • Fax: 318-473-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLA12660R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: