Healthcare Provider Details

I. General information

NPI: 1790848869
Provider Name (Legal Business Name): JOSE H URDAZ GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CALLE PEDRO MORA ACOSTA URB SAN LORENZO
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 280
BAJADERO PR
00616-0280
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-4113
  • Fax:
Mailing address:
  • Phone: 787-879-4113
  • Fax: 787-879-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4484
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: