Healthcare Provider Details

I. General information

NPI: 1548553209
Provider Name (Legal Business Name): RYAN MICHAEL URICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

PO BOX 27935
ALBUQUERQUE NM
87125-7935
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-8326
  • Fax:
Mailing address:
  • Phone: 505-727-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13117885-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD2014-0925
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2014-0925
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13117885-1205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2014-0925
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: