Provider Demographics
NPI:1952831208
Name:URQUIAGA, JORGE FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:FERNANDO
Last Name:URQUIAGA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3635 VISTA AVENUE
Mailing Address - Street 2:DEPT OF NEUROSURGERY 5TH FLOOR FDT
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-577-8715
Mailing Address - Fax:314-577-8720
Practice Address - Street 1:3655 VISTA AVENUE
Practice Address - Street 2:2ND FLOOR WEST PAVILION
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-577-8715
Practice Address - Fax:314-577-8720
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-07-31
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Provider Licenses
StateLicense IDTaxonomies
MO2017022725207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery