Provider Demographics
NPI:1962488908
Name:ASHBY, ERIC R (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:ASHBY
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 1:1660 W ANTELOPE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1165
Mailing Address - Country:US
Mailing Address - Phone:801-779-0700
Mailing Address - Fax:801-779-3636
Practice Address - Street 1:1660 W ANTELOPE DR STE 210
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1165
Practice Address - Country:US
Practice Address - Phone:801-779-0700
Practice Address - Fax:801-779-3636
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3403321205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0210Medicaid
UT002241008Medicare ID - Type Unspecified
UTD0210Medicaid
UT005701342Medicare ID - Type Unspecified
UT005536828Medicare ID - Type Unspecified