Individual
KEITH EMORY BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
7704 2ND ST NW STE A, ALBUQUERQUE, NM 87107-6755
(505) 873-7400
Mailing address
2001 CENTRO FAMILIAR BLVD SW, ALBUQUERQUE, NM 87105-4592
(505) 873-7400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3117
CO
363A00000X
Physician Assistant
Primary
PA2011-0057
NM
Other
Enumeration date
11/04/2010
Last updated
05/16/2025
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