Healthcare Provider Details

I. General information

NPI: 1285052696
Provider Name (Legal Business Name): MOSES TARHSONG ASHUKEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOSES T ASHUKEM MD

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 S SUGAR RD STE 200
EDINBURG TX
78539-9140
US

IV. Provider business mailing address

367 S GULPH RD
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 956-603-1333
  • Fax: 956-380-4433
Mailing address:
  • Phone: 956-603-1333
  • Fax: 956-380-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54102
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberT0706
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberT0706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: