MEDICARE: SARAH OGBEDEI ASHITEY M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program	24648194	TX
2	207Q00000X	Family Medicine Physician	Q1081	TX

General Provider Information

NPI Number	:	1851681456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH OGBEDEI ASHITEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	817-912-9050
Fax Number	:	817-912-9060

Provider Business Practice Location Address
First Line	:	2035 FORT WORTH HWY STE 100
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4783
Country	:	US
Telephone Number	:	817-912-9050
Fax Number	:	817-912-9060

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

Provider Enumeration Date	:	04/15/2011
Last Update Date	:	02/06/2019

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