Individual
DR. AMANDA WALTON BASFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6565 FANNIN ST, FONDREN 270, HOUSTON, TX 77030-2703
(713) 441-0006
(713) 790-2797
Mailing address
6565 FANNIN ST, FONDREN 270, HOUSTON, TX 77030-2703
(713) 441-0006
(713) 790-2797
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M1496
TX
207RN0300X
Nephrology Physician
Primary
M1496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
094010801
—
TX
01
—
1003834904
BLUE CROSS BLUE SHIELD
TX
05
—
184374001
—
TX
05
—
184374004
—
TX
01
—
P00947183
MEDICARE RR
TX
01
—
TXB110289
MEDICARE PTAN
—
Enumeration date
07/18/2006
Last updated
09/29/2011
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