Provider Demographics
NPI:1023085347
Name:URSETTA, TERRANCE T (DO)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:T
Last Name:URSETTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TERRANCE
Other - Middle Name:THOMAS
Other - Last Name:URSETTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4631 NW 31ST AVE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1779 N UNIVERSITY DR
Practice Address - Street 2:SUITE #101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-0929
Practice Address - Country:US
Practice Address - Phone:954-963-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5848207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01051387OtherRR MEDICARE
FL064549400Medicaid
FL80410OtherB/S FL
FL80410WOtherMEDICARE
FLP01051387OtherRR MEDICARE