MEDICARE: GREGORY DARYL URBAN M.D.

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	208200000X	Plastic Surgery Physician	29673	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240006078	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1578644670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY DARYL URBAN M.D.

Provider Business Mailing Address
First Line	:	1215 N 1ST ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2102
Country	:	US
Telephone Number	:	970-255-1720
Fax Number	:	970-255-1745

Provider Business Practice Location Address
First Line	:	1215 N 1ST ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2102
Country	:	US
Telephone Number	:	970-255-1720
Fax Number	:	970-255-1745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/13/2017

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