Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | ME0042819 | FL |
NPI | 1104045103 |
---|---|
Provider Name | Dr. Peter Urban |
First Address | Perry, FL 32347-2315 |
Second Address | Perry, FL 32347-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 22/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D27277 | (02) | FL |