Provider Demographics
NPI:1982961157
Name:ROBERTO S. IURCOVICH, MD PA
Entity Type:Organization
Organization Name:ROBERTO S. IURCOVICH, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PA
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:IURCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:407-423-0681
Mailing Address - Street 1:1811 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2918
Mailing Address - Country:US
Mailing Address - Phone:407-423-0681
Mailing Address - Fax:407-422-4860
Practice Address - Street 1:1811 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2918
Practice Address - Country:US
Practice Address - Phone:407-423-0681
Practice Address - Fax:407-422-4860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821108929OtherNPI
FL28080Medicare PIN
FLD53474Medicare PIN