Individual
NATHAN DANIEL BASCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
500 W 144TH AVE STE 230, WESTMINSTER, CO 80023-9328
(303) 665-2603
Mailing address
10790 RANCHO BERNARDO RD, SAN DIEGO, CA 92127-5705
(858) 554-7993
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
20A17978
CA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
20A17978
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/25/2018
Last updated
08/12/2024
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