Healthcare Provider Details

I. General information

NPI: 1811272990
Provider Name (Legal Business Name): JOHN UPEGUI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HARTFORD ST STE 1
HOULTON ME
04730-1844
US

IV. Provider business mailing address

22 HARTFORD ST STE 1
HOULTON ME
04730-1844
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-4068
  • Fax: 207-532-9426
Mailing address:
  • Phone: 207-532-4068
  • Fax: 207-532-9426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9106014
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2315
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: