Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | MD182192 | PW |
Y | 208800000X | Urologist | MD60620802 | WA |
NPI | 1013294941 |
---|---|
Provider Name | Dr. Matt S Ashley |
First Address | Bend, OR 97701-7691 |
Second Address | Bend, OR 97701-7691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2011 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500724795 | (05) | OR |