Provider Demographics
NPI:1326120635
Name:BASEMAN, DONALD A (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:BASEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9410 FOUNTAIN MEDICAL CT UNIT A102
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4525
Mailing Address - Country:US
Mailing Address - Phone:239-948-9600
Mailing Address - Fax:239-948-9603
Practice Address - Street 1:9410 FOUNTAIN MEDICAL COURT UNIT A102
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4202
Practice Address - Country:US
Practice Address - Phone:239-948-9600
Practice Address - Fax:239-948-9603
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651066074OtherTAX ID
FL651066074OtherTAX ID