Provider Demographics
NPI:1326154949
Name:BASWELL, BONNIE B (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:B
Last Name:BASWELL
Suffix:
Gender:F
Credentials:MD
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 9190
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80932-0190
Mailing Address - Country:US
Mailing Address - Phone:719-867-7800
Mailing Address - Fax:719-867-7899
Practice Address - Street 1:1235 LAKE PLAZA DR STE 218
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3556
Practice Address - Country:US
Practice Address - Phone:719-867-7800
Practice Address - Fax:719-867-7899
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19795207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01197953Medicaid
CO01197953Medicaid