Provider Demographics
NPI:1952386377
Name:URBACH, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:URBACH
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:PO BOX 23200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3200
Mailing Address - Country:US
Mailing Address - Phone:503-274-9678
Mailing Address - Fax:503-274-4281
Practice Address - Street 1:2525 NW LOVEJOY ST
Practice Address - Street 2:#402
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2859
Practice Address - Country:US
Practice Address - Phone:503-274-9678
Practice Address - Fax:503-274-4281
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16782OtherMEDICAL LICENSE NUMBER
ORF25150Medicare UPIN
R0000BLCHMMedicare PIN