Provider Demographics
NPI:1790848869
Name:URDAZ GOMEZ, JOSE H (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:H
Last Name:URDAZ GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-0280
Mailing Address - Country:US
Mailing Address - Phone:787-879-4113
Mailing Address - Fax:787-879-4113
Practice Address - Street 1:40 CALLE PEDRO MORA ACOSTA
Practice Address - Street 2:URB SAN LORENZO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4484207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27671OtherMEDICARE FIRST COAST SERVICE OPTIONS, INC.
600949OtherMMM
2893OtherPMC
C79687Medicare UPIN