Provider Demographics
NPI:1134305956
Name:WURDEMAN, ASHA GANPAT (DO)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:GANPAT
Last Name:WURDEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16655 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2329
Mailing Address - Country:US
Mailing Address - Phone:281-276-0827
Mailing Address - Fax:281-275-0760
Practice Address - Street 1:16655 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2329
Practice Address - Country:US
Practice Address - Phone:281-276-0827
Practice Address - Fax:281-275-0760
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR877207Q00000X
NE677207Q00000X, 207QH0002X
TXQ8681207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ8681OtherMEDICAL LICENSE
AZR877OtherTRAINING PERMIT