MEDICARE: MRS. JINYU SOH-URBANO 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	207Q00000X	Family Medicine Physician	ME62870	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00387705	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	25990	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942240767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JINYU SOH-URBANO MD

Provider Business Mailing Address
First Line	:	755 RINEHART RD
Second Line	:	SUITE 100
City	:	LAKE MARY
State	:	FL
Zip	:	32746-4874
Country	:	US
Telephone Number	:	407-333-1550
Fax Number	:	407-333-3081

Provider Business Practice Location Address
First Line	:	755 RINEHART RD
Second Line	:	SUITE 100
City	:	LAKE MARY
State	:	FL
Zip	:	32746-4874
Country	:	US
Telephone Number	:	407-333-1550
Fax Number	:	407-333-3081

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	06/13/2014

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