Provider Demographics
NPI:1043573355
Name:BASHAM, KYLE B (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:B
Last Name:BASHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:479-709-7295
Mailing Address - Fax:479-709-7296
Practice Address - Street 1:5500 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3222
Practice Address - Country:US
Practice Address - Phone:479-709-7295
Practice Address - Fax:479-709-7296
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2023-07-13
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Provider Licenses
StateLicense IDTaxonomies
ARE-10368208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty