MEDICARE: JEFFREY DWIGHT UPTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	5645	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790744209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DWIGHT UPTON MD

Provider Business Mailing Address
First Line	:	1525 VISTA LN
Second Line	:	STE 120
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4633
Country	:	US
Telephone Number	:	775-885-9991
Fax Number	:	775-883-0884

Provider Business Practice Location Address
First Line	:	1525 VISTA LN
Second Line	:	120
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4633
Country	:	US
Telephone Number	:	775-885-9991
Fax Number	:	775-883-0884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	02/03/2012

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