Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 125-066853 | IL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 25MA10793800 | NJ |
N | 207XS0117X | Orthopaedic Spine Surgeon | MD17601 | RI |
N | 207XS0117X | Orthopaedic Spine Surgeon | MD469688 | PA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | T287904 | MA |
NPI | 1124409032 |
---|---|
Provider Name | Dr. Bryce A Basques |
First Address | Providence, RI 02901-1119 |
Second Address | Raynham, MA 02767-5416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 07/09/2021 |