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General NPI Number Information
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NPI Number | 1588957328
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Entity Type | Individual
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Provider Name | JOSE GUSTAVO URRUTIA MADRID MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 11/17/2013
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Provider Practice Location Address
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Address Line | 5301 S. CONGRESS AVENUE
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City | ATLANTIS
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State | FL
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Zip | 33462
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Country | US
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Telephone | 561-548-1467
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Fax |
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Provider Business Mailing Address
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Address Line | 7156 COLONY CLUB DR APT. 204
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City | LAKE WORTH
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State | FL
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Zip | 33463-7836
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Country | US
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Telephone | 561-386-6395
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TRN16079
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License Number State | FL
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