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General NPI Number Information
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NPI Number | 1528066602
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Entity Type | Organization
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Legal Business Name | UROLOGIC PHYSICIANS & SURGEONS INC.
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2145 N FAIRFIELD RD SUITE B
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City | BEAVERCREEK
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State | OH
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Zip | 45431-2580
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Country | US
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Telephone | 937-429-7352
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Fax | 937-429-3772
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Provider Business Mailing Address
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Address Line | 2145 N FAIRFIELD RD SUITE B
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City | BEAVERCREEK
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State | OH
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Zip | 45431-2580
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Country | US
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Telephone | 937-429-7352
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Fax | 937-429-3772
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK R PENCE II
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Credential | MD
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Telephone | 937-429-7352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | OH
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