Provider Demographics
NPI:1417073750
Name:URODEL INC
Entity Type:Organization
Organization Name:URODEL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMOON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-775-3025
Mailing Address - Street 1:305 E GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5109
Mailing Address - Country:US
Mailing Address - Phone:830-775-3025
Mailing Address - Fax:830-768-4831
Practice Address - Street 1:305 E GARFIELD ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5109
Practice Address - Country:US
Practice Address - Phone:830-775-3025
Practice Address - Fax:830-768-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2437208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163208501Medicaid
TX150283302Medicaid
TX$$$$$$$$$OtherSOCIAL SECURITY NUMBER
TXF2437OtherLICENSE
TX163208501Medicaid
TX150283302Medicaid
TXH01226Medicare UPIN