Provider Demographics
NPI:1790932788
Name:BASOM, THON ARLYN (MD)
Entity Type:Individual
Prefix:
First Name:THON
Middle Name:ARLYN
Last Name:BASOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SHERIDAN
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67529
Mailing Address - Country:US
Mailing Address - Phone:620-569-2441
Mailing Address - Fax:
Practice Address - Street 1:304 SHERIDAN
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:KS
Practice Address - Zip Code:67529
Practice Address - Country:US
Practice Address - Phone:620-569-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0006151AMedicare UPIN