Provider Demographics
NPI:1053536813
Name:JURGEN H UPPLEGGER MD PC
Entity type:Organization
Organization Name:JURGEN H UPPLEGGER MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JURGEN
Authorized Official - Middle Name:HEINZ
Authorized Official - Last Name:UPPLEGGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-883-9570
Mailing Address - Street 1:4233 MONTGOMERY BLVD NE STE 140W
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6707
Mailing Address - Country:US
Mailing Address - Phone:505-883-9570
Mailing Address - Fax:505-883-4163
Practice Address - Street 1:4233 MONTGOMERY BLVD NE STE 140W
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6707
Practice Address - Country:US
Practice Address - Phone:505-883-9570
Practice Address - Fax:505-883-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM74-256208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty