Healthcare Provider Details

I. General information

NPI: 1851359749
Provider Name (Legal Business Name): ROBB ASHLEY MOTHERSHED DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 10/25/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 TRENWEST DR
WINSTON-SALEM NC
27103-3220
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-0710
  • Fax: 336-765-0821
Mailing address:
  • Phone: 336-765-0710
  • Fax: 336-765-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number373
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: