Provider Demographics
NPI:1245288109
Name:URQUIDI, ULYSSES (MD)
Entity type:Individual
Prefix:DR
First Name:ULYSSES
Middle Name:
Last Name:URQUIDI
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 1:8524 MOUNTAIN ASH DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-2442
Mailing Address - Country:US
Mailing Address - Phone:915-783-8162
Mailing Address - Fax:915-351-6601
Practice Address - Street 1:600 N.E. 4TH ST.
Practice Address - Street 2:
Practice Address - City:FABENS
Practice Address - State:TX
Practice Address - Zip Code:79838-7983
Practice Address - Country:US
Practice Address - Phone:915-765-5119
Practice Address - Fax:915-765-5126
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152119702Medicaid
TX8A0710Medicare ID - Type Unspecified
TX152119702Medicaid