Individual
BASCOM CLARENCE RANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9400 UNIVERSITY PKWY, SUITE 409, PENSACOLA, FL 32514-5752
(850) 208-6160
Mailing address
245 W AIRPORT BLVD, PENSACOLA, FL 32505-2254
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0051114
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010024345
RAILROAD MEDICARE
FL
01
—
04161
BLUE CROSS FLORIDA
FL
05
—
046121100
—
FL
01
—
103864
CAHABE GBA MEDICARE
—
01
—
59064837
BLUE CROSS ALABAMA
AL
01
—
660034400
RURAL HEALTH (MEDICAL)
FL
Enumeration date
06/16/2005
Last updated
05/19/2014
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