Provider Demographics
NPI:1932130440
Name:UPTON, E JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:E
Middle Name:JOSEPH
Last Name:UPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-0002
Mailing Address - Country:US
Mailing Address - Phone:936-258-4600
Mailing Address - Fax:936-258-4603
Practice Address - Street 1:107 BRYAN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2661
Practice Address - Country:US
Practice Address - Phone:936-258-4600
Practice Address - Fax:936-258-4603
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2859207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139422318Medicaid
E 78720Medicare UPIN
TX139422318Medicaid