Individual
BONNIE N. BASLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3411 W MAIN ST, TUPELO, MS 38801-9413
(662) 844-9376
(662) 844-4326
Mailing address
3411 W MAIN ST, TUPELO, MS 38801-9413
(662) 844-9376
(662) 844-4326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101235038
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010028914
—
VA
01
—
104944
ANTHEM
VA
01
—
298379
SOUTHERN HEALTH
VA
01
—
420016
COVENTRY HEALTH
VA
Enumeration date
06/30/2005
Last updated
03/24/2011
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