Individual
JACK B BASIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3219 CLIFTON AVE, SUITE 100, CINCINNATI, OH 45220-3027
(513) 862-1888
(513) 862-3616
Mailing address
PO BOX 635063, CINCINNATI, OH 45263-0001
(513) 891-1006
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
35084002
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200215750
—
IN
05
—
2473256
—
OH
05
—
64083140
—
KY
Enumeration date
08/19/2005
Last updated
09/17/2014
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