Provider Demographics
NPI:1518970904
Name:URIBE, EDUARDO JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JAVIER
Last Name:URIBE
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 1:103 W MANDALAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1502
Mailing Address - Country:US
Mailing Address - Phone:210-275-5305
Mailing Address - Fax:210-558-2000
Practice Address - Street 1:3201 CHERRY RIDGE DR STE C-317
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4823
Practice Address - Country:US
Practice Address - Phone:210-310-3960
Practice Address - Fax:210-558-2000
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4821207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111825907Medicaid
TX1118259-08Medicaid
TX8J7162Medicare PIN
TXG36462Medicare UPIN
TXG36462Medicare UPIN