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Individual

MR. MARK A BASHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
110 E 16TH ST, EUREKA, KS 67045-1067
(620) 583-7451
(620) 583-6702
Mailing address
110 E 16TH ST, EUREKA, KS 67045-1067
(620) 583-7451
(620) 583-6702

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0428069
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100362190B
KS
01
100428860A
GROUP MEDICAID
01
178960
RURAL HEALTH MEDICARE
01
640311
F. GUARD
Enumeration date
09/14/2005
Last updated
11/29/2023
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