MEDICARE: FERNANDO URRUTIA M.D. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548526510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNANDO URRUTIA M.D. P.A.

Provider Business Mailing Address
First Line	:	P.O. BOX 630248
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77263-0248
Country	:	US
Telephone Number	:	713-796-0035
Fax Number	:	713-796-0334

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST.
Second Line	:	SUITE #2280
City	:	HOUSTON
State	:	TX
Zip	:	77030-2334
Country	:	US
Telephone Number	:	713-796-0035
Fax Number	:	713-796-0334

Authorized Official
Title or Position	:	M.D.
Name	:	MR. FERNANDO URRUTIA
Credential	:	M.D.
Telephone Number	:	713-796-0035

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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