Provider Demographics
NPI:1649317819
Name:UPTMORE, DAVID JOSEPH JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:UPTMORE
Suffix:JR
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 1:21310 PROVINCIAL BLVD
Mailing Address - Street 2:SUITE 395
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:281-599-0404
Mailing Address - Fax:281-599-1655
Practice Address - Street 1:21310 PROVINCIAL BLVD
Practice Address - Street 2:SUITE 395
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:281-599-0404
Practice Address - Fax:281-599-1655
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4611207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI74058Medicare UPIN