Basic Information
| Provider Information | |||||||||
| NPI: | 1447538855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLEAVES | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | WOLODZKO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 CENTRAL PKWY S STE 400 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106535501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 502 MADISON OAK DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104951900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2011 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Q6194 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 356966702 | 05 | TX | MEDICAID |