MEDICARE: CAESAR MARCELO URSIC MD

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	208600000X	Surgery Physician	MD2005-0735	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QMYPR0071514	OTHER		MOLINA
2	10024240	OTHER		LOVELACE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	742912	OTHER		CCN
5	2587220	OTHER		UHC
6	202004080	OTHER		PRESBYTERIAN HEALTH PLANS
7	NM009X45	OTHER	NM	BCBS NM

General Provider Information

NPI Number	:	1891763652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAESAR MARCELO URSIC MD

Provider Business Mailing Address
First Line	:	455 SAINT MICHAELS DR
Second Line	:	MEDICAL STAFF OFFICE
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-820-5227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 HOSPITAL DR
Second Line	:	SUITE 240
City	:	SANTA FE
State	:	NM
Zip	:	87505-4728
Country	:	US
Telephone Number	:	505-954-8728
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/12/2007

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Directions to “ CAESAR MARCELO URSIC MD” Practice Location

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