Provider Demographics
NPI:1922039817
Name:BASKETT, GARY N (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:N
Last Name:BASKETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1020 SASSAFRASS DR
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-2151
Mailing Address - Country:US
Mailing Address - Phone:573-746-0144
Mailing Address - Fax:
Practice Address - Street 1:2505 MISSION DR STE 210
Practice Address - Street 2:WOUNDS CENTER
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-9508
Practice Address - Country:US
Practice Address - Phone:573-681-3187
Practice Address - Fax:573-681-3645
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242238723Medicaid
MO242238723Medicaid