Basic Information
Provider Information
NPI: 1417121047
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: URANGA
FirstName: JOE
MiddleName: ANTHONY
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 87
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782910087
CountryCode: US
TelephoneNumber: 2103589172
FaxNumber: 2103589183
Practice Location
Address1: 903 W MARTIN ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782070903
CountryCode: US
TelephoneNumber: 2103585467
FaxNumber: 2103586880
Other Information
ProviderEnumerationDate: 04/15/2008
LastUpdateDate: 11/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XN8588TXY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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