Provider Demographics
NPI:1730140435
Name:BASHOR, STEVEN BLAKE (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BLAKE
Last Name:BASHOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 RUSHOLME AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-0000
Mailing Address - Country:US
Mailing Address - Phone:563-421-7702
Mailing Address - Fax:
Practice Address - Street 1:1227 RUSHOLME AVE
Practice Address - Street 2:GENESIS EAST HOSPITAL
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803
Practice Address - Country:US
Practice Address - Phone:563-421-7681
Practice Address - Fax:563-421-7719
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03053207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2145078Medicaid
IA0145078Medicaid
IAC35205Medicare UPIN
IA0145078Medicaid