Provider Demographics
NPI:1790719789
Name:SO, ASHLEY U (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:U
Last Name:SO
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 1:6750 N MACARTHUR BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2484
Mailing Address - Country:US
Mailing Address - Phone:972-556-1616
Mailing Address - Fax:972-831-3931
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:STE. 350
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-556-1616
Practice Address - Fax:972-556-1740
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4134207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152234404Medicaid
TX152234402Medicaid
TX200839302Medicaid
TX152234401Medicaid
TX152234405Medicaid
TX200839302Medicaid
TXH65697Medicare UPIN
TX152234404Medicaid
TX200839302Medicaid