Provider Demographics
NPI:1174648240
Name:BASHA, JOSEPH WILLIAM JR (LP, CCP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:BASHA
Suffix:JR
Gender:M
Credentials:LP, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 TWIN BRIDGES RD
Mailing Address - Street 2:60
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2065
Mailing Address - Country:US
Mailing Address - Phone:318-623-0890
Mailing Address - Fax:
Practice Address - Street 1:920 TWIN BRIDGES RD
Practice Address - Street 2:60
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2065
Practice Address - Country:US
Practice Address - Phone:318-623-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPEF.200011282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital