Provider Demographics
NPI:1780847897
Name:GUBBELS, ASHLEY LYNN (MD)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:LYNN
Last Name:GUBBELS
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 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:
Practice Address - Street 1:500 W THOMAS RD STE 680
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4235
Practice Address - Country:US
Practice Address - Phone:024-066-0176
Practice Address - Fax:602-294-5515
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25710207V00000X
NE5383207V00000X
CAC156792207VG0400X
NY294891207VG0400X
AZ51808207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV831215Medicaid