Healthcare Provider Details

I. General information

NPI: 1528498557
Provider Name (Legal Business Name): JOHN L URBANEK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COMMUNITY LN
SOUTHWEST HARBOR ME
04679-4273
US

IV. Provider business mailing address

2951 MARINA BAY DR #130-559
LEAGUE CITY TX
77573-2735
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5630
  • Fax:
Mailing address:
  • Phone: 713-410-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK6378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: