Individual
CHARLES W BASCOM III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2120 W INA RD, TUCSON, AZ 85741-2694
(520) 395-0471
Mailing address
2600 W INA RD APT 197, TUCSON, AZ 85741-2347
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
241529
AZ
Other
Enumeration date
06/06/2020
Last updated
06/22/2020
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