Provider Demographics
NPI:1457644551
Name:DELACERDA, ASHLEY BRANDON (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BRANDON
Last Name:DELACERDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22000
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-7200
Mailing Address - Country:US
Mailing Address - Phone:325-658-1511
Mailing Address - Fax:325-481-2166
Practice Address - Street 1:220 E. HARRIS
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903
Practice Address - Country:US
Practice Address - Phone:325-481-2215
Practice Address - Fax:325-481-2180
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2892207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX418771YKRYOtherMEDICARE PTAN
TX346821701Medicaid
TX8FB936OtherBCBS