Provider Demographics
NPI:1497727523
Name:URDA, PETER JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:URDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1941 BISHOP LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1922
Mailing Address - Country:US
Mailing Address - Phone:502-375-3242
Mailing Address - Fax:502-375-4331
Practice Address - Street 1:1941 BISHOP LN
Practice Address - Street 2:SUITE 205
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1922
Practice Address - Country:US
Practice Address - Phone:502-375-3242
Practice Address - Fax:502-375-4331
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02528207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC35204Medicare UPIN