Healthcare Provider Details

I. General information

NPI: 1720607302
Provider Name (Legal Business Name): MONTANA UPTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 SUTTER ST
SAN FRANCISCO CA
94115-3038
US

IV. Provider business mailing address

6222 WASHINGTON BLVD
INDIANAPOLIS IN
46220-1829
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7494
  • Fax:
Mailing address:
  • Phone: 707-227-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01096256A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA211199
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: