Provider Demographics
NPI:1306818083
Name:BASHEIN, HAL J (DO)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:J
Last Name:BASHEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2051 45TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2027
Practice Address - Country:US
Practice Address - Phone:561-848-8700
Practice Address - Fax:561-848-7070
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 6143208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL204650OtherAVMED
FLP03512OtherFREEDOM
FL0642985OtherCIGNA
FL370525100Medicaid
FL4404227OtherAETNA
FLP01649227OtherRR MEDICARE
FL80572OtherBCBS
FLP971487OtherOPTIMUM
FL1241662OtherWELLCARE
FL3437OtherDIMENSION
FL1010099OtherCAREPLUS
FL80572YMedicare PIN
FLP01649227OtherRR MEDICARE
FLF19746Medicare UPIN