Provider Demographics
NPI:1588957328
Name:URRUTIA MADRID, JOSE GUSTAVO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GUSTAVO
Last Name:URRUTIA MADRID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7156 COLONY CLUB DR
Mailing Address - Street 2:APT. 204
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7836
Mailing Address - Country:US
Mailing Address - Phone:561-386-6395
Mailing Address - Fax:
Practice Address - Street 1:5301 S. CONGRESS AVENUE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-548-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN16079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine