Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 13846 | OK |
NPI | 1063411825 |
---|---|
Provider Name | John Robert Ashley |
First Address | Tulsa, OK 74136-3331 |
Second Address | Tulsa, OK 74136-8313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 12/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100123530C | (05) | OK |
D34346 | (02) | OK |