Basic Information
| Provider Information | |||||||||
| NPI: | 1609064195 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY CONSULTANTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 W STATE ROAD 434 | ||||||||
| Address2: | 302 | ||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327504981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073320777 | ||||||||
| FaxNumber: | 4073328767 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 W STATE ROAD 434 | ||||||||
| Address2: | 302 | ||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327504981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073320777 | ||||||||
| FaxNumber: | 4073328767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | JACOBO | ||||||||
| AuthorizedOfficialFirstName: | ELIAS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4073320777 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME0044908 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.