Provider Demographics
NPI:1861462368
Name:ASHWORTH, SIMEON WESLEY (DO)
Entity type:Individual
Prefix:
First Name:SIMEON
Middle Name:WESLEY
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3004
Mailing Address - Country:US
Mailing Address - Phone:253-985-1711
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-3004
Practice Address - Country:US
Practice Address - Phone:253-968-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-03-14
Deactivation Date:2019-02-08
Deactivation Code:
Reactivation Date:2019-03-14
Provider Licenses
StateLicense IDTaxonomies
WAOP00002255207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0226246OtherLIWA
WA0226247OtherLIWA
WA0226248OtherLIWA
WA5517ASOtherBSWA
WA8497836Medicaid
WA0226247OtherLIWA
WA5517ASOtherBSWA