Provider Demographics
NPI:1942200092
Name:URRUTIA, RICARDO FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:FRANKLIN
Last Name:URRUTIA
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 1:523 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4515
Mailing Address - Country:US
Mailing Address - Phone:972-298-8906
Mailing Address - Fax:972-298-6896
Practice Address - Street 1:523 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4515
Practice Address - Country:US
Practice Address - Phone:972-298-8906
Practice Address - Fax:972-298-6896
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8712208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092647902Medicaid
TX092647901Medicaid
TX092647901Medicaid