MEDICARE: DR. ASHLEY VERCELES DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	692091	TX

General Provider Information

NPI Number	:	1063999332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY VERCELES DPM

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2849 BARRON RD
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-9171
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	04/17/2024

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