Healthcare Provider Details

I. General information

NPI: 1467081521
Provider Name (Legal Business Name): BASIM ALI M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

A-44 YASEENABAD, FB AREA, BLOCK-9
KARACHI SINDH
74800
PK

V. Phone/Fax

Practice location:
  • Phone: 360-414-2730
  • Fax: 360-414-2739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD.MD.70040145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: