Provider Demographics
NPI:1518970904
Name:URIBE, EDUARDO JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JAVIER
Last Name:URIBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:227 N LOOP 1604 E
Mailing Address - Street 2:STE. 150
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1450
Mailing Address - Country:US
Mailing Address - Phone:866-456-7968
Mailing Address - Fax:866-456-0509
Practice Address - Street 1:227 N LOOP 1604 E STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1450
Practice Address - Country:US
Practice Address - Phone:210-901-5861
Practice Address - Fax:855-847-0003
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4821208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111825907Medicaid
TX1118259-08Medicaid
TX8J7162Medicare PIN
TXG36462Medicare UPIN
TXG36462Medicare UPIN