Provider Demographics
NPI:1629268842
Name:JESSE O BASADRE MD PA
Entity Type:Organization
Organization Name:JESSE O BASADRE MD PA
Other - Org Name:JESSE O BASADRE MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-857-5025
Mailing Address - Street 1:1699 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2074
Mailing Address - Country:US
Mailing Address - Phone:305-857-5025
Mailing Address - Fax:305-857-5024
Practice Address - Street 1:1699 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-857-5025
Practice Address - Fax:305-857-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1014909OtherNCPDP PROVIDER IDENTIFICATION NUMBER