Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD04558 | RI |
NPI | 1023090982 |
---|---|
Provider Name | Dr. John Urban |
First Address | Providence, RI 02905-2436 |
Second Address | Providence, RI 02905-2436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9001617 | (05) | RI |
C90650 | (02) | RI |