Healthcare Provider Details

I. General information

NPI: 1417994898
Provider Name (Legal Business Name): D SCOTT UPTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 AERO DR SUITE 130
SAN DIEGO CA
92123-1767
US

IV. Provider business mailing address

8765 AERO DRIVE SUITE 130
SAN DIEGO CA
92123-1767
US

V. Phone/Fax

Practice location:
  • Phone: 858-541-0181
  • Fax: 858-430-0919
Mailing address:
  • Phone: 858-541-0181
  • Fax: 858-430-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA84415
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberA84415
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA84415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: