Healthcare Provider Details

I. General information

NPI: 1013916428
Provider Name (Legal Business Name): IRA DAVID URETZKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PARK CENTRAL DR STE 100
COLUMBIA SC
29203-6469
US

IV. Provider business mailing address

145 PARK CENTRAL DR STE 100
COLUMBIA SC
29203-6469
US

V. Phone/Fax

Practice location:
  • Phone: 803-408-3277
  • Fax: 803-408-3299
Mailing address:
  • Phone: 803-408-3277
  • Fax: 803-408-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME151217
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number99-00706
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number61327
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: