Provider Demographics
NPI:1356303150
Name:URREA, ROBERT EDWARD
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:URREA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 EDGEMERE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3413
Mailing Address - Country:US
Mailing Address - Phone:915-881-8264
Mailing Address - Fax:915-881-8082
Practice Address - Street 1:6211 EDGEMERE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3413
Practice Address - Country:US
Practice Address - Phone:915-881-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4281207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029368002Medicaid
TX0067MWOtherBCBS
8D1658Medicare ID - Type Unspecified
TX029368002Medicaid