Individual
DR. JOHN H UPSHAW JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2770 3RD AVE STE 240, LAKE CHARLES, LA 70601-8994
(337) 494-4656
(337) 494-4657
Mailing address
PO BOX 122525 DEPT 2525, DALLAS, TX 75312-0001
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD.023910.R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1577731
—
LA
01
—
MD.023910.R
STATE MEDICAL LICENSE
LA
Enumeration date
07/29/2006
Last updated
04/28/2022
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