Provider Demographics
NPI:1902886351
Name:ROSS URWIN MD PA
Entity Type:Organization
Organization Name:ROSS URWIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:URWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:954-784-5140
Mailing Address - Street 1:PO BOX 5267
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33074
Mailing Address - Country:US
Mailing Address - Phone:954-784-5140
Mailing Address - Fax:954-784-3027
Practice Address - Street 1:1600 SOUTH FEDERAL HIGHWAY
Practice Address - Street 2:STE 200
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062
Practice Address - Country:US
Practice Address - Phone:954-784-5140
Practice Address - Fax:954-784-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2010-04-21
Deactivation Date:2009-04-08
Deactivation Code:
Reactivation Date:2010-04-21
Provider Licenses
StateLicense IDTaxonomies
FLME77663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257935900Medicaid
FL49127Medicare ID - Type Unspecified
FL257935900Medicaid