Provider Demographics
NPI:1184834111
Name:URSUA, VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:URSUA
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:PO BOX 1768
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77592-1768
Mailing Address - Country:US
Mailing Address - Phone:409-739-6119
Mailing Address - Fax:409-943-4515
Practice Address - Street 1:7111 MEDICAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2667
Practice Address - Country:US
Practice Address - Phone:409-739-6119
Practice Address - Fax:409-943-4515
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026506207X00000X
TXS0240207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1059927Medicaid
LA1059927Medicaid