Provider Demographics
NPI:1629159603
Name:BASYE, TOM R (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:R
Last Name:BASYE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:7905 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0616
Practice Address - Country:US
Practice Address - Phone:806-368-5837
Practice Address - Fax:806-368-5852
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK5066207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
14148509OtherCAQH
OK200033550AMedicaid
TX774417OtherMEDICARE
TX104571802Medicaid
NM41289056Medicaid
TX104571805Medicaid
TX81120SOtherBLUE CROSS & BLUE SHIELD
TX8KN294OtherBCBS