Provider Demographics
NPI:1659344513
Name:UEBELHOER, NATHAN S (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:S
Last Name:UEBELHOER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3406
Mailing Address - Country:US
Mailing Address - Phone:858-525-1439
Mailing Address - Fax:619-267-4835
Practice Address - Street 1:655 EUCLID AVE STE 304
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2974
Practice Address - Country:US
Practice Address - Phone:619-267-8303
Practice Address - Fax:619-267-4835
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9328207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A9328AMedicare ID - Type UnspecifiedGROUP#W7168
CAI24943Medicare UPIN