Provider Demographics
NPI:1477874477
Name:ASHWORTH, MICHELLE THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:THERESA
Last Name:ASHWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:2410 ROUND ROCK AVE STE 150
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4019
Practice Address - Country:US
Practice Address - Phone:512-341-8724
Practice Address - Fax:512-687-0295
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111370207R00000X
TXP8842207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01487958OtherRAILROAD MEDICARE
TX337804401Medicaid
TX337804402Medicaid
TXP01487958OtherRAILROAD MEDICARE