Provider Demographics
NPI:1518987494
Name:UPTERGROVE, RICHARD WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WADE
Last Name:UPTERGROVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WADE
Other - Middle Name:
Other - Last Name:UPTERGROVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:43590 FM 2481
Mailing Address - Street 2:
Mailing Address - City:HICO
Mailing Address - State:TX
Mailing Address - Zip Code:76457-3104
Mailing Address - Country:US
Mailing Address - Phone:254-485-9663
Mailing Address - Fax:
Practice Address - Street 1:8020 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4779
Practice Address - Country:US
Practice Address - Phone:682-222-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27187Medicare UPIN