1952831208 NPI number — DR. JORGE FERNANDO URQUIAGA MD

Table of content: DR. JORGE FERNANDO URQUIAGA MD (NPI 1952831208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952831208 NPI number — DR. JORGE FERNANDO URQUIAGA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URQUIAGA
Provider First Name:
JORGE
Provider Middle Name:
FERNANDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952831208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3635 VISTA AVENUE
Provider Second Line Business Mailing Address:
DEPT OF NEUROSURGERY 5TH FLOOR FDT
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-577-8715
Provider Business Mailing Address Fax Number:
314-577-8720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3655 VISTA AVENUE
Provider Second Line Business Practice Location Address:
2ND FLOOR WEST PAVILION
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-577-8715
Provider Business Practice Location Address Fax Number:
314-577-8720
Provider Enumeration Date:
06/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  2017022725 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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