Provider Demographics
NPI:1326236555
Name:BASHNER, BRIAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:BASHNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 JENSEN CT
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7483
Mailing Address - Country:US
Mailing Address - Phone:805-374-2000
Mailing Address - Fax:805-374-9491
Practice Address - Street 1:110 JENSEN CT
Practice Address - Street 2:SUITE 2A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7483
Practice Address - Country:US
Practice Address - Phone:805-374-2000
Practice Address - Fax:805-374-9491
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2013-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58678207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
W12137Medicare UPIN
CAWG58678BMedicare PIN