Provider Demographics
NPI:1528059722
Name:URSONE, RICHARD LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:URSONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 CONCORD PLAZA DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6991
Mailing Address - Country:US
Mailing Address - Phone:210-396-5246
Mailing Address - Fax:210-396-5249
Practice Address - Street 1:400 CONCORD PLAZA DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6991
Practice Address - Country:US
Practice Address - Phone:210-396-5246
Practice Address - Fax:210-396-5249
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14776R207X00000X
TXM7713207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00594ROtherMEDICARE GROUP PTAN
TX5288879OtherCIGNA
TX7054807OtherAETNA
1528059722OtherNPI
1528059722OtherNPI