Provider Demographics
NPI:1871523548
Name:UPSHAW, MORSE KILBURN (DPM)
Entity type:Individual
Prefix:DR
First Name:MORSE
Middle Name:KILBURN
Last Name:UPSHAW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:626-405-1031
Mailing Address - Fax:626-405-1037
Practice Address - Street 1:301 S FAIR OAKS AVE STE 207
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:626-405-1031
Practice Address - Fax:626-405-1037
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2383213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E23831Medicaid
CAT19191Medicare UPIN
CA000E23831Medicaid
CA4563710001Medicare NSC
CAE2383Medicare ID - Type Unspecified