Healthcare Provider Details

I. General information

NPI: 1548240898
Provider Name (Legal Business Name): RICHARD STEVEN URSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MATLOCK RD
ARLINGTON TX
76015-2908
US

IV. Provider business mailing address

PO BOX 201606
DALLAS TX
75320-1606
US

V. Phone/Fax

Practice location:
  • Phone: 817-472-4869
  • Fax:
Mailing address:
  • Phone: 972-758-3598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH5810
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: