Doctor Name: | DEREK KURT URBAN |
NPI Number: | 1033197454 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 068200 |
Business Practice Address: | 2200 Bergquist Dr Suite 1 Lackland A F B, TX - 782369908 |
Business Phone Number: | 2102926707 |
Business Fax Number: | |
Mailing Address: | 2200 Bergquist Dr, LACKLAND A F B |
State: | TX |
Postal Code: | 782369908 |
Phone Number: | 2102926707 |
Fax Number: | |
NPI Enumeration Date: | 01/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | 068200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |