Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 500048 | TX |
NPI | 1073578324 |
---|---|
Provider Name | Mr. Gene Basham |
First Address | The Woodlands, TX 77380-3218 |
Second Address | The Woodlands, TX 77380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/07/2007 |