Provider Demographics
NPI:1386880631
Name:JOSE ANTONIO URQUIDEZ, MD, PA
Entity type:Organization
Organization Name:JOSE ANTONIO URQUIDEZ, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:URQUIDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-249-5583
Mailing Address - Street 1:11851 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2338
Mailing Address - Country:US
Mailing Address - Phone:512-249-5583
Mailing Address - Fax:512-249-5593
Practice Address - Street 1:11851 JOLLYVILLE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2338
Practice Address - Country:US
Practice Address - Phone:512-249-5583
Practice Address - Fax:512-249-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4709Medicare UPIN