Individual
RYAN BASHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
00A121146
CA
207W00000X
Ophthalmology Physician
125054496
IL
Other
Enumeration date
06/30/2008
Last updated
02/16/2015
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