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General NPI Number Information
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NPI Number | 1033197454
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Entity Type | Individual
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Provider Name | DEREK KURT URBAN MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 2200 BERGQUIST DR SUITE 1
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City | LACKLAND A F B
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State | TX
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Zip | 78236-9908
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Country | US
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Telephone | 210-292-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 BERGQUIST DR
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City | LACKLAND A F B
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State | TX
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Zip | 78236-9908
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Country | US
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Telephone | 210-292-6707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 068200
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 50461
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License Number State | TN
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