Provider Demographics
NPI:1629142336
Name:URSEA, ROXANA (MD)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:URSEA
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 1:6060 N FOUNTAIN PLAZA DR
Mailing Address - Street 2:STE 250
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7873
Mailing Address - Country:US
Mailing Address - Phone:520-877-4240
Mailing Address - Fax:520-877-4241
Practice Address - Street 1:707 N ALVERNON WAY STE 301
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1848
Practice Address - Country:US
Practice Address - Phone:520-694-1460
Practice Address - Fax:520-694-1464
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32898207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ932477Medicaid
102673Medicare ID - Type Unspecified
AZ932477Medicaid