Provider Demographics
NPI:1457445066
Name:BAZEMORE, W CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:CARL
Last Name:BAZEMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4519
Mailing Address - Country:US
Mailing Address - Phone:828-255-7733
Mailing Address - Fax:828-258-3084
Practice Address - Street 1:30 CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4519
Practice Address - Country:US
Practice Address - Phone:828-255-7733
Practice Address - Fax:828-258-3084
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33609207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913968Medicaid
NCE04331Medicare UPIN
NC8913968Medicaid