MEDICARE: MR. CHARLES ASHFORD

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1356133532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES ASHFORD

Provider Business Mailing Address
First Line	:	4830 CEDAR SPRINGS RD APT 22
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-1364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 CEDAR SPRINGS RD APT 22
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-1364
Country	:	US
Telephone Number	:	806-392-2876
Fax Number	:

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

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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Directions to “ MR. CHARLES ASHFORD ” Practice Location

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