Healthcare Provider Details

I. General information

NPI: 1134305956
Provider Name (Legal Business Name): ASHA GANPAT WURDEMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16655 SOUTHWEST FWY
SUGAR LAND TX
77479-2329
US

IV. Provider business mailing address

16655 SOUTHWEST FWY
SUGAR LAND TX
77479-2329
US

V. Phone/Fax

Practice location:
  • Phone: 281-276-0827
  • Fax: 281-275-0760
Mailing address:
  • Phone: 281-276-0827
  • Fax: 281-275-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR877
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number677
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number677
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberQ8681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: