Provider Demographics
NPI:1821108929
Name:IURCOVICH, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:IURCOVICH
Suffix:
Gender:M
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:PO BOX 522468
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-2468
Mailing Address - Country:US
Mailing Address - Phone:407-423-0681
Mailing Address - Fax:407-422-4860
Practice Address - Street 1:1811 LUCERNE TERRACE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2918
Practice Address - Country:US
Practice Address - Phone:407-423-0681
Practice Address - Fax:407-422-4860
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28080Medicare ID - Type Unspecified
D53474Medicare UPIN