Basic Information
| Provider Information | |||||||||
| NPI: | 1780119669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASHLEY | ||||||||
| FirstName: | DEPTMER | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6431 FANNIN ST STE MSB 4020 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257222 | ||||||||
| FaxNumber: | 7135006829 | ||||||||
| Practice Location | |||||||||
| Address1: | 6431 FANNIN ST STE MSB 1434 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257222 | ||||||||
| FaxNumber: | 7135006829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD-21001 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 73591 | WI | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 68264 | MN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.