Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G68890 | CA |
Y | 208600000X | Surgeon | G68890 | CA |
NPI | 1023053592 |
---|---|
Provider Name | Dr. Bradley Basinger |
First Address | San Bernardino, CA 92423-0069 |
Second Address | Redlands, CA 92373-5916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 06/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G688900 | (05) | CA |
E56235 | (02) | CA |