Provider Demographics
NPI:1225457088
Name:GAETANO URSO, DO PA
Entity Type:Organization
Organization Name:GAETANO URSO, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAIN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAETANO
Authorized Official - Middle Name:
Authorized Official - Last Name:URSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-920-0746
Mailing Address - Street 1:10866 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5117
Mailing Address - Country:US
Mailing Address - Phone:813-920-0746
Mailing Address - Fax:
Practice Address - Street 1:10866 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5117
Practice Address - Country:US
Practice Address - Phone:813-920-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 1630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty