Provider Demographics
NPI:1306057732
Name:URBINA, RICHARD A (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:URBINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847522
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7522
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-435-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007508A207P00000X
MI5101016000207P00000X
TXP2388207P00000X
VA0102202607207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-048OtherTRICARE
TX304014911Medicaid
TX75-1976930-005OtherTRICARE
TX8GL020OtherBCBS
TX75-0818167-015OtherTRICARE
OH0046422Medicaid
TX75-0818167-044OtherTRICARE
TXP01784199OtherRAIL ROAD MEDICARE
TX304014903Medicaid
TX304014912Medicaid
TX8GL019OtherBCBS
TXP01773613OtherRAIL ROAD MEDICARE
TX75-0818167-044OtherTRICARE
TX304014903Medicaid