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NPI Code Detail

MEDICARE: ROBERTA ASHLEY EKHOLM DO

MEDICARE: ROBERTA ASHLEY EKHOLM DO
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
1207Q00000XFamily Medicine PhysicianOS14892FL

General Provider Information

NPI Number : 1780781609
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA ASHLEY EKHOLM DO
Provider Business Mailing Address
First Line : 300 CLYDE MORRIS BLVD STE A
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-5909
Country : US
Telephone Number : 386-317-8620
Fax Number : 386-317-8625
Provider Business Practice Location Address
First Line : 300 CLYDE MORRIS BLVD STE A
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32174-5909
Country : US
Telephone Number : 386-317-8620
Fax Number : 386-317-8625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 01/18/2024

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Directions to “ ROBERTA ASHLEY EKHOLM DO” Practice Location

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