Healthcare Provider Details

I. General information

NPI: 1346347432
Provider Name (Legal Business Name): BRIAN D ASHDOWN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 WILLETTA ST SW STE D2
ALBANY OR
97321-3451
US

IV. Provider business mailing address

2605 WILLETTA ST SW STE D2
ALBANY OR
97321-3451
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-3413
  • Fax: 877-437-6974
Mailing address:
  • Phone: 541-928-3413
  • Fax: 877-437-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDP00309
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: