Healthcare Provider Details

I. General information

NPI: 1497804678
Provider Name (Legal Business Name): IVAN C. ASHTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11613 N CENTRAL EXPY STE 121
DALLAS TX
75243-3842
US

IV. Provider business mailing address

11613 N CENTRAL EXPY STE 121
DALLAS TX
75243-3842
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-0670
  • Fax: 877-486-1749
Mailing address:
  • Phone: 214-691-0760
  • Fax: 214-691-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: