Provider Demographics
NPI:1255320958
Name:MERI, BASEM (DO)
Entity type:Individual
Prefix:DR
First Name:BASEM
Middle Name:
Last Name:MERI
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 1:2851 S AVE B
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-344-4308
Mailing Address - Fax:928-344-1737
Practice Address - Street 1:2851 S AVE B
Practice Address - Street 2:SUITE 3000
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-344-4308
Practice Address - Fax:928-344-1737
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ443325Medicaid
AZAZ0841230OtherBCBS AND TRICARE
AZ443325Medicaid
AZZ24629Medicare PIN