Provider Demographics
NPI:1164764890
Name:BASHAM, JESSICA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:BASHAM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6301 UNIVERSITY COMMONS STE 230
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1590
Mailing Address - Country:US
Mailing Address - Phone:574-251-2100
Mailing Address - Fax:574-251-2150
Practice Address - Street 1:515 N LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1003
Practice Address - Country:US
Practice Address - Phone:574-232-2037
Practice Address - Fax:574-232-1470
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2018-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01078045A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology