Individual
STEPHEN D BAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3676 PARKER BLVD, PUEBLO, CO 81008-2212
(719) 553-2208
(719) 553-2223
Mailing address
PO BOX 9000, PUEBLO, CO 81008-9000
(719) 553-2208
(719) 553-2223
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004346
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08431701
—
CO
Enumeration date
05/24/2005
Last updated
01/18/2016
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