Provider Demographics
NPI:1609064195
Name:UROLOGY CONSULTANTS
Entity Type:Organization
Organization Name:UROLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACOBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-332-0777
Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:302
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4981
Mailing Address - Country:US
Mailing Address - Phone:407-332-0777
Mailing Address - Fax:407-332-8767
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:302
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4981
Practice Address - Country:US
Practice Address - Phone:407-332-0777
Practice Address - Fax:407-332-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A03252Medicare UPIN
FL77070Medicare PIN
E89239Medicare UPIN