MEDICARE: THADDEUS ASHMORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	H6014	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8EH320	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P01338224	OTHER	TX	RAILROAD

General Provider Information

NPI Number	:	1306849690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THADDEUS ASHMORE MD

Provider Business Mailing Address
First Line	:	PO BOX 840853
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0853
Country	:	US
Telephone Number	:	972-233-1999
Fax Number	:	972-233-3666

Provider Business Practice Location Address
First Line	:	6606 LBJ FWY
Second Line	:	200
City	:	DALLAS
State	:	TX
Zip	:	75240
Country	:	US
Telephone Number	:	972-715-5000
Fax Number	:	972-715-9976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/21/2021

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Directions to “ THADDEUS ASHMORE MD” Practice Location

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