Provider Demographics
NPI:1316030596
Name:BASINGER, ROBERT G (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:BASINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2228
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022
Mailing Address - Country:US
Mailing Address - Phone:530-221-1666
Mailing Address - Fax:530-221-2111
Practice Address - Street 1:923 DANA DR
Practice Address - Street 2:STE 1
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4051
Practice Address - Country:US
Practice Address - Phone:530-221-1666
Practice Address - Fax:530-221-2111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1633213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11016Medicare UPIN
CA5531770001Medicare NSC
CA000E16330Medicare PIN