Provider Demographics
NPI:1053357871
Name:URQUIDEZ, JOSE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:URQUIDEZ
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 1:11851 JOLLYVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2350
Mailing Address - Country:US
Mailing Address - Phone:512-541-2591
Mailing Address - Fax:
Practice Address - Street 1:11851 JOLLYVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2350
Practice Address - Country:US
Practice Address - Phone:512-541-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9942207PE0004X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170229202Medicaid
TX8BK240OtherBCBS OF TEXAS
TX8K7997Medicare PIN
TX8BK240OtherBCBS OF TEXAS