MEDICARE: DR. RICHARD WADE UPTERGROVE 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	207Q00000X	Family Medicine Physician	H2858	TX

General Provider Information

NPI Number	:	1518987494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WADE UPTERGROVE MD

Provider Business Mailing Address
First Line	:	43590 FM 2481
Second Line	:
City	:	HICO
State	:	TX
Zip	:	76457-3104
Country	:	US
Telephone Number	:	254-485-9663
Fax Number	:

Provider Business Practice Location Address
First Line	:	8020 MATLOCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4779
Country	:	US
Telephone Number	:	682-222-7670
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/07/2017

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