Provider Demographics
NPI:1356310023
Name:BASDEN, DOLORES DURR (MD)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:DURR
Last Name:BASDEN
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 1:1760 E RIVER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:2625 N CRAYCROFT RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2254
Practice Address - Country:US
Practice Address - Phone:520-324-4214
Practice Address - Fax:520-324-2680
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ423799Medicaid
AZ423799Medicaid
AZZ74049Medicare PIN
AZF32175Medicare UPIN