Individual
JAMES W. BASTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1960 NE 47TH ST, 2ND FLOOR, FT LAUDERDALE, FL 33308-7708
(954) 493-5005
(954) 938-0957
Mailing address
1960 NE 47TH ST, 2ND FLOOR, FT LAUDERDALE, FL 33308-7708
(954) 493-5005
(954) 938-0957
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0023287
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79173
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/22/2005
Last updated
07/08/2007
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