Provider Demographics
NPI:1649264755
Name:URBI, EDWIN ROMMEL (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:ROMMEL
Last Name:URBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:ROMMEL SOLDAD
Other - Last Name:URBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6221 GRAND OAK DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2334
Mailing Address - Country:US
Mailing Address - Phone:318-473-1909
Mailing Address - Fax:318-473-1909
Practice Address - Street 1:4120 JACKSON STREET EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2752
Practice Address - Country:US
Practice Address - Phone:318-473-0035
Practice Address - Fax:318-443-0220
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA12660R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1539368Medicaid
5A439Medicare ID - Type Unspecified
LA1539368Medicaid