Individual
PETER HENRY BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 W 24TH ST, HOLLAND, MI 49423-4791
(616) 396-0006
Mailing address
111 W 24TH ST, HOLLAND, MI 49423-4791
(616) 396-0006
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301088667
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12094092
CAQH
MI
01
—
1295937332
BLUE CROSS / BLUE SHIELD
—
Enumeration date
06/01/2007
Last updated
01/19/2011
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