Provider Demographics
NPI:1235149196
Name:ASH, JEFFREY (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ASH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W COUNTRY CLUB RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5249
Mailing Address - Country:US
Mailing Address - Phone:575-625-2669
Mailing Address - Fax:575-625-1296
Practice Address - Street 1:300 W COUNTRY CLUB RD STE 130
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5249
Practice Address - Country:US
Practice Address - Phone:575-625-2669
Practice Address - Fax:575-625-1296
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4583990001OtherDMERC
NMNPI & TINOtherBCBS OF NM
NM55155863Medicaid
NMNPI & TINOtherBCBS OF NM