Provider Demographics
NPI:1588607709
Name:ASTBURY, JEFFREY ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALBERT
Last Name:ASTBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 FOREST EDGE LN
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1642
Mailing Address - Country:US
Mailing Address - Phone:214-478-9637
Mailing Address - Fax:214-241-4829
Practice Address - Street 1:516 FOREST EDGE LN
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-1642
Practice Address - Country:US
Practice Address - Phone:214-478-9637
Practice Address - Fax:214-241-4829
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043616403Medicaid
TX84Y714OtherBCBS
TX8BR063OtherBCBS
TX0436164-02Medicaid
TX84Y714OtherBCBS
TX043616403Medicaid
TXP00715739Medicare PIN
TX110116968Medicare PIN
TX8F9782Medicare PIN