Provider Demographics
NPI:1033197363
Name:ASHLOCK, STEVEN (M D)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ASHLOCK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SAN JUAN CT
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8542
Mailing Address - Country:US
Mailing Address - Phone:432-561-5110
Mailing Address - Fax:432-561-5110
Practice Address - Street 1:520 E 6TH ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4527
Practice Address - Country:US
Practice Address - Phone:432-582-8290
Practice Address - Fax:432-582-8931
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ39662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1376022-13Medicaid
TXF70982Medicare UPIN
TX1376022-13Medicaid