Provider Demographics
NPI:1568855880
Name:BASA, JAMESON
Entity Type:Individual
Prefix:
First Name:JAMESON
Middle Name:
Last Name:BASA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 475 BOX 1554
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350-1554
Mailing Address - Country:US
Mailing Address - Phone:315-243-5036
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL YOKOSUKA, PSC 475
Practice Address - Street 2:
Practice Address - City:YOKOSUKA-SHI
Practice Address - State:KANAGAWA-KEN
Practice Address - Zip Code:2380001
Practice Address - Country:JP
Practice Address - Phone:315-243-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman