Provider Demographics
NPI:1639155880
Name:ASHLEY, JEFFREY L (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 517
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4806
Mailing Address - Country:US
Mailing Address - Phone:818-845-8538
Mailing Address - Fax:818-845-8355
Practice Address - Street 1:2720 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3034
Practice Address - Country:US
Practice Address - Phone:818-842-8000
Practice Address - Fax:323-935-8804
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30335207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOG303350Medicaid
CAG30335Medicare ID - Type Unspecified
A44383Medicare UPIN