Provider Demographics
NPI:1982894374
Name:RECORD, ASHLEY COREIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:COREIL
Last Name:RECORD
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 1:20474 OLD SCENIC HWY
Mailing Address - Street 2:P.O. BOX 1160
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7365
Mailing Address - Country:US
Mailing Address - Phone:225-654-1124
Mailing Address - Fax:225-654-7079
Practice Address - Street 1:20474 OLD SCENIC HWY
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7365
Practice Address - Country:US
Practice Address - Phone:225-654-1124
Practice Address - Fax:225-654-7079
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2009-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200350207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4N487OtherMEDICARE SERVICES/PART B PROGRAM