Healthcare Provider Details

I. General information

NPI: 1326238650
Provider Name (Legal Business Name): ROBERT BLAIR ASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W. LAVETA AVE.
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 714-734-6250
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC52450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: