Provider Demographics
NPI:1346243714
Name:BASHFORD, KENT PARIS (DO)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:PARIS
Last Name:BASHFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1307
Mailing Address - Country:US
Mailing Address - Phone:970-221-2222
Mailing Address - Fax:970-221-4286
Practice Address - Street 1:1725 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1307
Practice Address - Country:US
Practice Address - Phone:970-221-2222
Practice Address - Fax:970-221-4286
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41243207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93425040Medicaid
CO93425040Medicaid
COH65542Medicare UPIN