Provider Demographics
NPI:1033422779
Name:URRUTIA, ENRIQUE JOSE JR (DO)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:JOSE
Last Name:URRUTIA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:12020 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-2805
Mailing Address - Country:US
Mailing Address - Phone:727-588-9572
Mailing Address - Fax:727-584-3832
Practice Address - Street 1:12020 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2805
Practice Address - Country:US
Practice Address - Phone:727-588-9572
Practice Address - Fax:727-584-3832
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2012-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GB705ZMedicare PIN