Provider Demographics
NPI:1306004924
Name:URSIC, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:URSIC
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 1:8300 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6801
Mailing Address - Country:US
Mailing Address - Phone:352-871-3542
Mailing Address - Fax:
Practice Address - Street 1:8300 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6801
Practice Address - Country:US
Practice Address - Phone:352-871-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 390200000X
NV148822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ726893Medicaid
AZP01114204OtherRR MEDICARE
NVP01248873OtherRR MEDICARE
NVP01218844OtherRR MEDICARE
CA1306004924Medicaid
AZ726893Medicaid
AZZ90040Medicare PIN
NVP01218844OtherRR MEDICARE
AZP01114204OtherRR MEDICARE