Healthcare Provider Details

I. General information

NPI: 1720217862
Provider Name (Legal Business Name): ROBERT K BASTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

IV. Provider business mailing address

PO BOX 9520
EL PASO TX
79995-9520
US

V. Phone/Fax

Practice location:
  • Phone: 915-783-8100
  • Fax: 915-783-8187
Mailing address:
  • Phone: 915-783-8100
  • Fax: 915-783-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number42465-TEMP
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: