Provider Demographics
NPI:1568767663
Name:D. THOMAS URBAN M.D., INC
Entity Type:Organization
Organization Name:D. THOMAS URBAN M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDNET/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-268-9660
Mailing Address - Street 1:6501 CROWN BLVD.
Mailing Address - Street 2:SUITE #106A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2903
Mailing Address - Country:US
Mailing Address - Phone:408-268-9660
Mailing Address - Fax:408-268-9662
Practice Address - Street 1:6501 CROWN BLVD.
Practice Address - Street 2:SUITE #106A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2903
Practice Address - Country:US
Practice Address - Phone:408-268-9660
Practice Address - Fax:408-268-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A202480207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22092Medicare UPIN