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General NPI Number Information
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NPI Number | 1437351079
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Entity Type | Organization
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Legal Business Name | CAPITOL UROLOGY, INC.
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 1525 VISTA LN 120
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City | CARSON CITY
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State | NV
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Zip | 89703-4626
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Country | US
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Telephone | 775-885-9991
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 VISTA LN 120
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City | CARSON CITY
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State | NV
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Zip | 89703-4626
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Country | US
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Telephone | 775-885-9991
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY DWIGHT UPTON
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Credential | MD
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Telephone | 775-885-9991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5645
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License Number State | NV
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