Healthcare Provider Details

I. General information

NPI: 1235149196
Provider Name (Legal Business Name): JEFFREY ASH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W COUNTRY CLUB RD STE 130
ROSWELL NM
88201-5249
US

IV. Provider business mailing address

300 W COUNTRY CLUB RD STE 130
ROSWELL NM
88201-5249
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-2669
  • Fax: 575-625-1296
Mailing address:
  • Phone: 575-625-2669
  • Fax: 575-625-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number300
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: