Provider Demographics
NPI:1881615417
Name:PETERSON-BRIGGS, ASHLEY DAISY (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:DAISY
Last Name:PETERSON-BRIGGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3663
Mailing Address - Country:US
Mailing Address - Phone:541-618-6444
Mailing Address - Fax:541-618-6452
Practice Address - Street 1:229 W STEWART AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3663
Practice Address - Country:US
Practice Address - Phone:541-618-6444
Practice Address - Fax:541-618-6452
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20945MD207Q00000X, 207VG0400X, 208000000X
ORMD20945208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR105049OtherMEDICARE GROUP PIN
OR150769Medicaid
ORBP4081206OtherDEA
ORF90643Medicare UPIN
ORR136544Medicare PIN