Basic Information
Provider Information
NPI: 1316297005
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: UPTON
FirstName: ASHLEY
MiddleName: REN'EE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6431 FANNIN ST RM 5.170
Address2:  
City: HOUSTON
State: TX
PostalCode: 770301501
CountryCode: US
TelephoneNumber: 7135006113
FaxNumber: 7135000648
Practice Location
Address1: 6431 FANNIN ST RM 5.170
Address2:  
City: HOUSTON
State: TX
PostalCode: 770301501
CountryCode: US
TelephoneNumber: 7135006113
FaxNumber: 7135000648
Other Information
ProviderEnumerationDate: 09/11/2012
LastUpdateDate: 05/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000XQ5943TXN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207L00000XQ5943TXY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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