Individual
MR. PAUL BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 KINGFISHER LN, TIJERAS, NM 87059-7432
(262) 501-4140
Mailing address
30 KINGFISHER LN, TIJERAS, NM 87059-7432
(262) 501-4140
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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