Provider Demographics
NPI:1235321464
Name:BASIL, ANTHONY AROCKIADOSS (IDC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:AROCKIADOSS
Last Name:BASIL
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 ARNOLD CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5414
Mailing Address - Country:US
Mailing Address - Phone:210-671-4062
Mailing Address - Fax:
Practice Address - Street 1:1250 ARNOLD CIR STE 1
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5414
Practice Address - Country:US
Practice Address - Phone:210-671-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman