Provider Demographics
NPI:1023075504
Name:POND, ASHLEY D (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:POND
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 1:1397A WEIMER ROAD PO BOX DD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-758-8883
Mailing Address - Fax:
Practice Address - Street 1:1397A WEIMER RD
Practice Address - Street 2:DD
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6284
Practice Address - Country:US
Practice Address - Phone:505-758-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78-242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C98035Medicare UPIN