| Paul B Bascom Md Llc | |
|
94220 4th St Gold Beach OR 97444-7756 | |
| (503) 961-2017 | |
| Not Available |
| Full Name | Paul B Bascom Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 94220 4th St, Gold Beach, Oregon |
| Authorized Official Name and Position | Paul B Bascom (OWNER) |
| Authorized Official Contact | 5039612017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul B Bascom Md Llc 2660 Crimson Canyon Dr Ste 130 Las Vegas NV 89128-0846 Ph: (503) 961-2017 | Paul B Bascom Md Llc 94220 4th St Gold Beach OR 97444-7756 Ph: (503) 961-2017 |
| NPI Number | 1710307046 |
|---|---|
| Provider Enumeration Date | 04/25/2014 |
| Last Update Date | 08/09/2023 |
| Medicare PECOS PAC ID | 2264657212 |
|---|---|
| Medicare Enrollment ID | O20140707000827 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710307046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD16983 (Oregon) | Primary |
| Provider Name | Paul B Bascom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689680134 PECOS PAC ID: 7517926157 Enrollment ID: I20140428001230 |
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