Provider Demographics
NPI:1548311350
Name:URUETA, WILFRIDO (MD)
Entity type:Individual
Prefix:DR
First Name:WILFRIDO
Middle Name:
Last Name:URUETA
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 1:4605 E ELWOOD ST STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-1978
Mailing Address - Country:US
Mailing Address - Phone:480-256-1524
Mailing Address - Fax:
Practice Address - Street 1:13350 N 94TH DR STE A101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4826
Practice Address - Country:US
Practice Address - Phone:623-974-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60448377207R00000X
MI4301093328207R00000X
AZ41933208M00000X, 207R00000X
ORMD191089208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ145775Medicare PIN
AZZ145776Medicare PIN