Provider Demographics
NPI:1932276425
Name:UPSHAW, WILLIAM NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NATHAN
Last Name:UPSHAW
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 1:943 HARBOUR BAY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5738
Mailing Address - Country:US
Mailing Address - Phone:813-731-5807
Mailing Address - Fax:
Practice Address - Street 1:943 HARBOUR BAY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5738
Practice Address - Country:US
Practice Address - Phone:813-731-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME962752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1464GOtherBLUE CROSS BLUE SHIELD
FLCH935ZMedicare PIN
FL001043600Medicaid