Provider Demographics
NPI:1487643169
Name:URBAN, JANN LEE (MD)
Entity Type:Individual
Prefix:
First Name:JANN
Middle Name:LEE
Last Name:URBAN
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 1:4001 LAUREL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5300
Mailing Address - Country:US
Mailing Address - Phone:907-277-7246
Mailing Address - Fax:
Practice Address - Street 1:4001 LAUREL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5300
Practice Address - Country:US
Practice Address - Phone:907-277-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.098349207L00000X
AK5298207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5298Medicaid
AKP00416036OtherMEDICARE RAILROAD
WA8428484OtherWA MEDICAID
WA0217350OtherWA DEPT OF LABOR
F69885Medicare UPIN
AKMD5298Medicaid