Provider Demographics
NPI:1285732669
Name:UPTON, HENRY Y (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:Y
Last Name:UPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 VETERANS BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1734
Mailing Address - Country:US
Mailing Address - Phone:650-368-3937
Mailing Address - Fax:650-368-0270
Practice Address - Street 1:805 VETERANS BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1734
Practice Address - Country:US
Practice Address - Phone:650-368-3937
Practice Address - Fax:650-368-0270
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG238030207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00207171OtherRRM PIN
CAZZZ09989ZOtherBLUE SHIELD TEARSE GROUP
DC7365OtherRRM TEARSE GROUP
CA00G28030Medicaid
CAG23803OtherLICENSE
CA00G238030Medicare PIN
P00207171OtherRRM PIN
CAG23803OtherLICENSE