Provider Demographics
NPI:1760583314
Name:BASHFORD, EILEEN A (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:A
Last Name:BASHFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 KARNES BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3629
Mailing Address - Country:US
Mailing Address - Phone:816-807-5542
Mailing Address - Fax:
Practice Address - Street 1:3422 KARNES BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3629
Practice Address - Country:US
Practice Address - Phone:816-807-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9G38207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203642301Medicaid
MOP00295283Medicare PIN
MOS556933Medicare PIN
MO203642301Medicaid
MOC51695Medicare UPIN