Provider Demographics
NPI:1548526510
Name:FERNANDO URRUTIA M.D. P.A.
Entity type:Organization
Organization Name:FERNANDO URRUTIA M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:URRUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-796-0035
Mailing Address - Street 1:P.O. BOX 630248
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77263-0248
Mailing Address - Country:US
Mailing Address - Phone:713-796-0035
Mailing Address - Fax:713-796-0334
Practice Address - Street 1:6624 FANNIN ST.
Practice Address - Street 2:SUITE #2280
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2334
Practice Address - Country:US
Practice Address - Phone:713-796-0035
Practice Address - Fax:713-796-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135677604Medicaid
TXE-20505Medicare UPIN