Provider Demographics
NPI:1588667232
Name:ROEDER, URSULA VANESSA (MD)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:VANESSA
Last Name:ROEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 E PARADISE FALLS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6687
Mailing Address - Country:US
Mailing Address - Phone:520-689-7030
Mailing Address - Fax:520-395-9796
Practice Address - Street 1:3700 E FORT LOWELL RD STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1729
Practice Address - Country:US
Practice Address - Phone:520-881-0631
Practice Address - Fax:520-230-3310
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-08-30
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
AZ16141208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00203Medicare UPIN
AZMD16141Medicare ID - Type Unspecified