Provider Demographics
NPI:1386682326
Name:BASAR, IRUM (MD)
Entity Type:Individual
Prefix:DR
First Name:IRUM
Middle Name:
Last Name:BASAR
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 1:1250 E CLIFF DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4850
Mailing Address - Country:US
Mailing Address - Phone:915-577-7951
Mailing Address - Fax:915-577-7952
Practice Address - Street 1:1250 E CLIFF DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4850
Practice Address - Country:US
Practice Address - Phone:915-577-7951
Practice Address - Fax:915-577-7952
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP00042084N0400X
NC2009017012084N0400X
MN482422084N0400X
CODR.00562262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79780091Medicaid
CO028973OtherKSISER COMMERCIAL NUMBER
MN130001263Medicare ID - Type Unspecified