Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | H4864 | TX |
NPI | 1063421279 |
---|---|
Provider Name | George Perry Ashby |
First Address | La Porte, TX 77572-1518 |
Second Address | La Porte, TX 77571-6498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 12/07/2007 |