Healthcare Provider Details

I. General information

NPI: 1316995681
Provider Name (Legal Business Name): MICHAEL URBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 ROYAL CT
MEDFORD OR
97504-6130
US

IV. Provider business mailing address

PO BOX 1705
MEDFORD OR
97501-0132
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-7273
  • Fax: 541-773-2027
Mailing address:
  • Phone: 541-773-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number30366
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD215045
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: