Healthcare Provider Details

I. General information

NPI: 1467605360
Provider Name (Legal Business Name): ROY F. ASHFORD, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER SUITE 200
GLENDALE CA
91206-4071
US

IV. Provider business mailing address

4330 OAKWOOD AVE
LA CANADA CA
91011-3411
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-8974
  • Fax: 818-246-8790
Mailing address:
  • Phone: 818-790-2086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG64893
License Number StateCA

VIII. Authorized Official

Name: DR. ROY F ASHFORD
Title or Position: OWNER
Credential: M.D.,
Phone: 818-269-7477