Healthcare Provider Details

I. General information

NPI: 1962660266
Provider Name (Legal Business Name): JOSE IGNACIO URIBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 HIGH POINT BLVD SUITE 100
BETHLEHEM PA
18017-7809
US

IV. Provider business mailing address

3445 HIGH POINT BLVD SUITE 100
BETHLEHEM PA
18017-7809
US

V. Phone/Fax

Practice location:
  • Phone: 610-866-5555
  • Fax: 610-866-2006
Mailing address:
  • Phone: 610-866-5555
  • Fax: 610-866-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD434423
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: