Provider Demographics
NPI:1952367906
Name:UYEMURA, MONTE C (MD)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:C
Last Name:UYEMURA
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 1:1017 W 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758-1420
Mailing Address - Country:US
Mailing Address - Phone:970-332-4895
Mailing Address - Fax:970-332-3235
Practice Address - Street 1:1017 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-1420
Practice Address - Country:US
Practice Address - Phone:970-332-4895
Practice Address - Fax:970-332-3235
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01314756Medicaid
362478Medicare ID - Type Unspecified
COF40366Medicare UPIN
F40366Medicare UPIN