=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558761973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A. ELAINE ASHBY, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2014
-----------------------------------------------------
Last Update Date | 09/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3732 MT DIABLO BLVD STE 385
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94549-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-283-1210
-----------------------------------------------------
Fax | 925-283-1310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3732 MT DIABLO BLVD STE 385
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94549-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-283-1210
-----------------------------------------------------
Fax | 925-283-1310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. A. ELAINE ASHBY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 925-283-1210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 00G519401
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------